Camille Robcis’s Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France is a lively and timely intervention into a variety of fields. The book takes its name from the concept of disalienation about which Frantz Fanon wrote his original medical dissertation that was rejected by his committee and later published as Black Skin, White Masks (1952). The concept names one of the challenges facing human societies today in terms of the arrangement of institutional life and the role that norms and relationships play in human flourishing. Robcis’s analysis traces the origins and development of a movement in psychiatry called institutional psychotherapy (1945–1975) that today (at least up until Robcis’s work) is rarely understood under that name and its intellectual foundations. This is so despite the movement’s profound influence on many psychiatrists and many of the most well-known intellectuals of the post-World War II era, particularly in France. Robcis explicates the history of the institutional psychotherapy movement, beginning with François Tosquelles and then exploring its extensions and transformations in the work of Jean Oury, Frantz Fanon, Felix Guattari, and Michel Foucault, among others.
The interest of this text to scholars of social and political philosophy, political theory, philosophy of science, and philosophy of race is self-evident. This text is extremely valuable in contextualizing Fanon, Guattari, and Foucault within an often-neglected intellectual history. It also should be of interest to those working through theoretical questions around the creolization of theory. This is so not just because of its insights on Fanon, but also for the ways that Robcis’s text can be understood as offering a creolizing account of some of the icons of Francophone philosophy and political thought: Foucault, Guattari, and Guattari’s frequent collaborator, Gilles Deleuze, are often read as avatars of a sort of “pure” post-structuralism, emerging merely as a reaction to the excesses of Marxism, existentialism, and psychoanalysis. Robcis’s text is useful in reading these figures in light of and also against an intellectual and political current of liberatory praxis that, as in the case of Fanon, extended beyond the colonial metropole. In short, this text is a novel contribution to the project of creolizing French theory.
In what follows, I seek to take up these currents by, in effect, reading the text as creolizing our understanding of psychiatry as a political praxis. Robcis claims that in his attempt to decolonize institutional psychotherapy, Frantz Fanon “perfected” the practice. Although assessment of that claim is beyond the scope of my ambitions here, I find it an inspiring thought. To study Robcis’s text is to grasp the enormity of what it would mean to genuinely perfect institutional psychotherapy. Taking seriously that the enormity of the project would require interpreting institutional psychotherapy not as simply movement in psychiatry, but instead as a movement of psychiatric origins necessarily involving much broader political practice. To that end, I’ll offer an interpretation of Tosquelles’s contributions as being meaningful contributions to political theory. I’ll start by providing a synopsis of Robcis’s account of the development of institutional psychotherapy by Tosquelles and his colleagues at Saint-Alban. Then I’ll discuss Tosquelles’s account of collective transference as a psychiatric theory that not only involves political change in psychiatry but has implications for political theory more broadly.
Saint-Alban, Institutional Psychotherapy, and the Problem of Alienation
Where the Nazis pursued a policy of “hard” genocide, the Vichy regime in France followed a plan of “soft extermination” (1). Its prisons and asylums were put to this end as politico-institutional technologies that housed the criminal, the mentally ill, the disabled; the queer and sexually deviant; the “proletarians of the sick” (40)—the Blacks, the Jews, the indigènes; and the politically dissident. All these categories of persons were considered, within the Euromodern framework, “mad.” It was commonplace for asylums to “forget” to feed the patients, or allow them to freeze to death during winters. In some asylums, the doctors simply had no money or resources to run the institution—and this was by design.
As Robcis’s breathtaking work chronicles, one hospital fought back. Saint-Alban was home to the first generation of pioneers of a radical movement within psychiatry (1945–1975) that sought to reform and humanize it through a practice called institutional psychotherapy. Among the founding members was François Tosquelles, a Catalan antifascist psychiatrist who sought to bring psychoanalysis back into psychiatry and couple it with Marxian political analysis.
Tosquelles had experienced multiple “occupations” in his lifetime: Spanish imperialism, French fascism, and Stalinist domination over the European Communist parties. He sought to eradicate all forms of occupation and what he termed “concentrationism” through his practice, not simply from the human personality but from the institutions and normative frameworks within which it is embedded. These tendencies toward colonizing behavior and the authoritarian personality, as well as what might today be called coercive power’s “settler” dimensions, were, for Tosquelles, symptomatic of “the-all-power” (le-tout-pouvoir), a concept reminiscent of what Julia Suárez-Krabbe has more recently termed, drawing upon decolonial thought, “the death project” in her magnificent study of the Mamos in Sierra Nevada de Santa Marta.
Institutional psychotherapy called into question the relationship between illness and alienation, which are not isometric concepts. In this regard, Robcis notes the double meaning of the French word aliéné (“alienated”), which was often used simply to mean mental illness. “Alienation was a psychic state—being mad, insane—but also a social condition that left patients feeling estranged, trapped, isolated from others” (10). Tosquelles and his colleagues, then, endeavored to address a sense of double alienation, irreducible to illness. Of the patients at Saint-Alban, Tosquelles remarked, “Are these people sick? Does this notion of ‘sickness’ encompass all of the meanings of mental alienation?” (38)
Thus, for proponents of institutional psychotherapy, “madness was never a personal affair” (38). Some illness was neurologically rooted, but some was a function of failing norms and institutions, symptoms of a sick society. Hence, only the meeting of psychiatry and social mechanisms could ameliorate it. Georges Daumézon, another major theorist of the movement, concluded that whereas “the doctor can fight illness, only society can fight alienation” (40).
Addressing alienation’s roots becomes tricky because one needs to account for disparate domains—neurological, psychic, sociological, political—as ones that nevertheless interact. One can be neurologically ill but have the benefit, by virtue of institutional design, of living among dis-alienating norms and relationships. Yet by the same token, institutional transformation is no panacea; one may also be neurologically and even mentally healthy but still experience alienation by virtue of the hostility of a racist world. Mental illness need not always entail alienation, and alienation does not necessarily entail individual pathology. It could, for instance, also indicate social or political failure. Tosquelles and his colleagues thus saw madness in society, not just in their patients. Thus, they thought its study was a key to understanding political relations.
Institutional psychotherapy also attended to the ways that institutions not only are shaped by but shape human action. Many make the error of associating institutions intrinsically with coercion; institutional psychotherapy took seriously the capacity of institutions to instead empower. The institutional psychotherapy advocated by Tosquelles also differed from anti-psychiatrists who rejected all neurological bases for mental illness. Evidence of this is that they often prescribed medication. Following Lacan, who Fanon argued in his medical dissertation was correct when asserting that “madness is a pathology of freedom,” the Saint-Alban school argued that the goal of therapy was freedom. This meant that the job of the psychiatrist was to reinstitute the social in the human personality. For Hermann Simon, an important influence on Tosquelles, this necessitated a “more active therapy,” one which took advantage of the organization of the hospital, the land it was on, and the patients’ families and social networks (22). It required revolutionizing the hospital staff and breaking down both physical and logistical barriers, de-carceralizing the institution. The nurses were asked to take off their uniforms and dress indistinguishably from the patients. “Walls” separating the administrative and medical divisions of the hospital were torn down; everyone who worked there, including the patients, began to take responsibility for running the institution and playing an active role in the healing process.
Saint-Alban’s approach was a far cry from the influential notion of “moral therapy” advanced in the early nineteenth century by Philippe Pinel. Pinel advocated putting patients to work to alleviate specific symptoms, but Pinel’s “moral therapy” sought to put people to work in order to beat the symptoms out of them. Rejecting this antiquated paradigm, institutional psychotherapy sought to liberate the individual through resocialization and the development of a sense of belonging. The goal was to connect individuals to institutional life so they could become, to use Fanon’s term, actional. Having a role to play is necessary but insufficient for such an outcome. For the doctors who made the Saint-Alban experiment, the purpose of assigning patients responsibility was to help them reenter a world of meaning through which to realize a sense of shared commitments and values oriented around the projects and goals of the institution.
It was in this milieu at Saint-Alban that Fanon, the revolutionary psychiatrist and philosopher, did his medical residency. There, many of Fanon’s theories about the structural relationship between power and mind, and about the political nature of psychiatry—a field dominated by biological essentialism—were confirmed and nurtured. To readers familiar with Fanon’s work, Robcis’s text makes the resonances from Saint-Alban quite obvious. Tosquelles, Jean Oury, and director Paul Balvet turned a decrepit and perpetually underfunded hospital, where patients faced absolutely miserable conditions, into a living and breathing organism. Doctors helped patients grow food for the hospital community, create unions and clubs where they could discuss finances and a vision for the institution, and put on cultural events. They established a ward journal so that patients could experience what it means to write and to be read and listened to. This facilitated the patients’ coming outside of and externalizing themselves through language, or the realm of the symbolic. Later, Saint-Alban became home to group therapies and administrative meetings numbering in the hundreds per year. One doctor, Marius Bonnet, reflecting upon the democratic structure of the hospital, said: “Basically, when I think back to this period, I often wonder: in Saint-Alban, who cured who?” (41). Every feature of the environment—the entire web of relations governing the doctors, nurses, patients, administration, gardeners, cooks, etc.—needed to be dis-alienated, de-carceralized, de-segregated, etc., such that the patients worked not only to disalienate themselves but the world of which they were a part. Tosquelles, indeed, imagined institutional psychotherapy as “an attempt to cure life itself” (2).
Collective Transference and Political Disalienation
Here I will focus on Tosquelles’ unique theory of transference, one of the three theoretical interventions of the Saint-Alban school and a pillar of what Robcis means by disalienation. To contextualize this intervention, I will recount a story from Tosquelles’ life which explains how the Catalonian native ended up in France anyway.
Early in his career, Tosquelles experimented with organizing the comarcas—local regions or districts in Catalonia—in ways that facilitated psychiatric treatment. He wanted to administer treatment by district and have the community involved. At this time, he was head of a Marxist unification party that fought moderates and Franco sympathizers and which had communists, anarchists, and all stripes of leftists in its membership. Tosquelles fought in the Spanish Civil War, which had in large part been caused by the Spanish colonization of Catalonia. In defeat, he was exiled and fled to France, controlled at that time by the Vichy regime.
His first stop was a refugee camp, Camp de Judes in Stepfonds. The camp’s carceral environment was such that it would be best to think of it as a concentration camp or prison. Conditions were harsh, “causing many to die from hunger, disease, or exhaustion and driving others to suicide” (Robcis, 28). They were surrounded by barbed wire, electric fences, and rifle-carrying military personnel. Food was scarce, and detainees slept in haystacks with “deplorable hygienic and sanitary conditions” while being routinely brutalized by guards (28–29). In addition to “barbed wire disease,” the refugees called the noxious effects of the camp “sand-itis” as a way to articulate how the elements of mud and sand literally entered one’s body and soul. Often, the overall atmosphere was so bleak that detainees could not even cry; one detainee remarked, “I feel like crying to dry the ink with which I am writing, for my tears have turned to sand” (30).
Amazingly, Tosquelles operated a psychiatric clinic from inside the camp. Worried about the rampant psychic disarray and suicides, he set up a treatment service that allowed him to test many of the theories that later became the disalienating practices of Saint-Alban. These improvised experiments in humanization “convinced Tosquelles that psychiatry could be practiced anywhere” (2). In fact, years later Tosquelles even said that the camp was “one of the places where I conducted very good psychiatry, in this concentration camp, in the mud” (31).
Important among such theories was an alternative theory of unconscious transference. Freud postulated that an unconscious (affective) transference takes place in the one-on-one context of psychoanalytic treatment between doctor and patient. His theory proved exceptionally accurate when it came to neurotics but not in cases of psychosis, and so it was abandoned in treatments of the latter. Tosquelles thought that institutions, when organized properly, could function as a backdrop for the unconscious projections and fantasies of neurotic and psychotic patients alike; in that way, it could play a role akin to that of the doctor. In short, institutions were alive and could facilitate a collective transference. Here is Robcis on this dimension of Tosquelles’ thinking:
Tosquelles described the hospital as a field invested with social significance: “for most of our patients, the acts, the delusions, and the confessions often refer to intimate conflicts that are always intersocial, and more specifically familial. We can sometimes bring to light the chain of associations linked to these conflicts that tends to lead us back to typical childhood situations similar to the ones described by psychoanalysts.” In this context, Tosquelles continued: the hospital can play a role analogous to that of the psychoanalyst. It can be the object of consecutive projections of these conflicts. The dialectic of the cure would go through this mill [laminoir] of transferences and projections facilitated by the hospital.” As Tosquelles suggested, the hospital could circumvent some of the theoretical and practical difficulties that Freud had encountered in his treatment of psychotics by providing a different model of transference. (40, my emphasis)
As we have seen, much was required for this alternative collective transference to take place. The hospital and the entire profession of psychiatry needed to be “cured” such that the institution could go from functioning as a Sartrean practico-inert to a living entity. The hospital, Tosquelles thought, could become a new kind of home in a sick world. Its rules could encourage patients to no longer feel compelled to adjust themselves to a sick reality outside. But the institution would have to emerge from its seriality, to de-carceralize itself, and operate according to a radically horizontalizing distribution of power. Patients would need to “buy in.” They would need to be taught to question everything. Anyone should be allowed to raise a rule as the subject of debate.
Moreover, the “dialectic of the cure” Tosquelles referenced means disalienation is not an equilibrium state to be attained. It has no predetermined endpoint. Norms and institutions can always be made healthier; creating increasingly empowering relationships is a horizon in motion. Although its results cannot be calculated in advance in the same fashion that one could calculate the effects of a specific drug dosage on the body (though even this is an inexact science), it is a science nonetheless. There is no telling what individuals will bring to the table when coaxed out of their neuroses and brought into a world where momentum pushes them to flourish. Disalienation is also a dialectical concept because of what it implies about time. At Saint-Alban the project of curing the hospital produced a sense of historicity among patients who had previously been severed from their existential link to time. They began to connect to each other and to the doctors with whom they built a global history of the institution. This history was not immune to political reality outside the hospital; it was, indeed, deeply in touch with it.
This story of a man practicing “very good psychiatry” in a concentration camp implies that the alternative collective transference necessary for disalienating institutions can happen in contexts far outside where ordinary psychiatrists might look. This is precisely what Fanon concluded. What Fanon took from his time at Saint-Alban and brought to the Blida-Joinville hospital in Algeria, as Robcis contends, advanced institutional psychotherapy by light-years. He organized in Tunisia what is likely the first day clinic on the African continent so that patients could continue living with their families while receiving treatment, and work through their traumas geographically close to where they were originally imprinted. Fanon broke down the walls of the-all-power by organizing trips where nurses could accompany patients and observe how they behaved in actual social situations. He encouraged nurses to socialize and dine with the patients, something prohibited beforehand. His most radical innovation was his suggestion that social movements could facilitate collective transference.
Readers are perhaps familiar with Fanon’s arguments in A Dying Colonialism (1959) and The Wretched of the Earth (1961). The former explores disalienation in the context of the Algerian war for national liberation, which led to a series of radical social mutations that took place in the people through critically reshaping institutions such as the family, media, and medicine. The latter argued that violent armed struggle against the forces of domination and unfreedom took a nation hiding from itself to one which began to exhibit genuine national consciousness. Robcis’s text alerts us, then, to the ways in which Fanon’s contributions to political theory and liberatory philosophy are extensions of the collective transference theorized by Tosquelles.
One wonders about Robcis’ account of disalienation and how it might illuminate the political activity of some of the most politically progressive movements on earth today. Struggles like those waged by the Zapatistas in Chiapas, Mexico, or by Abahlali BaseMjondolo—the shack dwellers who began in Durban, South Africa at the turn of the century—are not only valuable to the political scientist because they are examples of resistance against Euromodernity. They are interesting because they instantiate experiments in revolutionary democracy that define themselves, in part, by reference to dis-alienating practices and relationships. Many of the institutions which I grew up with and took for granted as indispensably necessary for society may not be so. The political activity of these groups is pregnant with a new kind of human being who needs new kinds of institutions which may or may not resemble the hospitals and schools and courts and governments of the past.
In short, if one were to purchase Robcis’s book only for its first chapters on Tosquelles, they would have invested their money wisely. That the text’s riches extend well beyond this means it is an easy recommendation: this is a book that both demands and rewards engagement. Robcis’s account of institutional psychotherapy is of a concept and movement that some have sought to bury in the past yet which appears profoundly relevant to the project of imagining and building a desirable future.
Gregory Evan Doukas
Gregory Evan Doukas is a postdoctoral researcher in Political Science at the University of Memphis. His work as a political theorist focuses on the question of political responsibility in existential and Africana diasporic thought. He is currently working on a series of articles related to his dissertation Political Responsibility in Tumultuous Times which he plans, next year, to transform into a monograph.