Review: Camille Robcis, Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France (Chicago: The University of Chicago Press, 2021)
Janina Klement (University College London)
In January 1940, the Catalan refugee psychiatrist Francesc Tosquelles who had just arrived in France, was recruited to work with the French psychiatrist Paul Balvet. Since 1937, Balvet had been the director of a dilapidated and overcrowded asylum in the village of Saint-Alban-sur-Limagnole in Lozère which, situated 1000 metres above sea level in the mountains, counted itself among France’s most impoverished regions. In a giant communal effort that included the local villagers, they prepped the asylum for the war, piled food reserves and planted and harvested produce together with the patients, ultimately saving the asylum population from starvation. Next to its main function as a sanatorium, Saint-Alban became an assembly spot for persecuted intellectuals who began participating in the therapy of the mentally ill, and soon pushed for theorisation of their practice. In 1941, a manifesto with first principles emerged but only eleven years later, in 1952, the term “institutional psychotherapy” first appeared in a journal article.
With Disalienation, Camille Robcis delivers the first history of the French institutional psychotherapy movement for an anglophone readership. The book’s work is to position institutional psychotherapy as a set of ethics of everyday life and experience, and to read it as a political theory (with the ambition of contemporary applicability) of alienation, the unconscious and institutions, more so than to assess its therapeutic merits. Prior to its denomination and introduction to medical literature, institutional psychotherapy was a humanitarian and intuitive act of care during war-time. The bookcover blurb’s claim that Saint-Alban was the only asylum that ‘attempted to resist’ the Vichy regime’s “soft extermination” programme of the mentally ill through supply shortages conceals a dispute among historians (which remains unrectified by the book itself) whether many psychiatrists across France tried the same thing, but ultimately failed to rescue most of their patients. The clinic’s favourable geographical location in the mountains as well as Balvet’s good relationship with the Pétain administration arguably helped Saint-Alban to escape the occupiers and collaborators’ ruthless supervision.
After the war, institutional psychotherapy was carried forward as a practice, subjected to multiple reinventions while transgressing its original geopolitical context. By organising the chapters around four key institutional psychotherapists, Tosquelles, Frantz Fanon, Félix Guattari and Michel Foucault, Robcis achieves to write a biography of a movement, tracing the intersecting yet distinctive practical and intellectual contributions that brought it into being, and that kept it in circulation for the better part of the second half of the twentieth century.
The first chapter knits together the story of how Francesc Tosquelles, a well-read experimental combat psychiatrist, anarchist, and co-founder of the Catalan federalist and anti-Stalinist activist group POUM (Partido Obrero de Unificación Marxista), became François Tosquelles, inventor of institutional psychotherapy and inspirational figure for the French health reform, that implemented the Catalan inspired concept of “sector psychiatry” nationwide in the 1960s. Institutional psychotherapy is born when after the war, Tosquelles’ équipe tore down the walls surrounding Saint-Alban to create an “asylum-village” allowing for more contacts with the local population. Moreover, the German psychiatrist Hermann Simon’s idea of a “more active treatment in the asylum” inspired the creation of a “healing collective” that actively involved patients in the structuring of everyday life in the hospital to treat the institution more than the individual. According to Jacques Lacan’s doctoral thesis, which first received recognition and practical application in the context of Saint-Alban, psychosis had to be grasped in its ‘phenomenal totality…the entirety of its historical existence’ (p. 38). Thus, as Robcis argues, the idea that the social and the psychic were intimately connected and had to be transformed collectively to escape alienation was the fundamental lesson that Tosquelles and his équipe transmitted to future generations of institutional psychotherapists.
The second chapter uncovers the early steps of Frantz Fanon’s hitherto lesser examined medical career, as Robcis seeks to ‘restate the significance of Fanon in the genealogy of what is generally called “Western radical psychiatry”’ (p. 51). The institutional psychotherapists’ dogma to treat the social and the psychic at the same time resonated with Fanon’s understanding of subjectivity as structural and therefore ‘fundamentally shaped by the social and political context’ (p. 59). The chapter follows him from medical school in Lyon to his brief internship in Saint-Alban, where he was involved with various art and ergo therapies, wrote pieces for the hospital newsletter and advocated together with Tosquelles for a limited use of electroshock therapy, to facilitate personality reconstruction. Yet his subsequent arrival at the Algerian psychiatric clinic of Blida-Joinville was marked by an initial ‘total failure’ (p. 66) to apply Saint-Alban-style social therapy. Arabic staff and patients were equally repulsed by the innovations forced upon them, and only the European patients responded positively to Fanon’s reshuffling of social roles and expectations in the hospital. Fanon retreated for a journey through Algeria which prompted him to reflect on his own complicity with colonial regimes, discovering the necessity to “decolonise” institutional psychotherapy. Upon his return he restructured institutional psychotherapy to the effect that Muslim patients began to enjoy socialising in the hospital space, for example through performances of Muslim singers and professional storytellers, and popular Algerian table games at the hospital’s new “Café maure”.
In this chapter the book is at its most romantic. Robcis masterfully narrates Fanon’s intellectual and personal trajectory beyond cultural and language barriers which he successfully overcame through self-sacrifice and careful introspection. By its finale, he has shaken off the European grip on institutional psychotherapy to arrive at ‘a truly disalienated and disalienating psychiatry’ (p. 68). The absence of patient perspectives in the book is quite noticeable here, as despite Robcis’ initial insistence that her interest is not to write a hagiography (p. 9), her narration tends strongly in this direction throughout the book and is furthermore reflected in her decision to focus on the contributions of four celebrated male practitioners to the movement.
Chapter three is a remarkably condensed and accessible tour de force of French intellectual history surrounding the events of May ’68 and the arrival of institutional psychotherapy in Paris, through figures such as Jean Oury, Félix Guattari and Gilles Deleuze. Robcis shows how institutional psychotherapy was radicalised at Oury’s “Clinique de la Borde,” on the premise of an “anti-oedipal” politics that sought to disalienate ‘the unconscious, the familial, the social, and the political, all at once’ (p. 78). The chapter’s main contribution to existing historiography is its attentiveness to how Guattari pronounced institutional psychotherapy’s potential to transform and express group desire, pushing the discourse into nonmedical contexts, especially urban planning, left-wing organising and working groups, among others on feminism, health policies, pedagogy and theatre.
The book’s final and arguably strongest chapter circles around Michel Foucault’s role in the development of institutional psychotherapy. Anyone who thought Foucault’s contribution is best explained by starting with his analysis of power is offered a captivating new reading (as well as a picture of him with a full head of hair). Although he never actually practised institutional psychotherapy, Robcis reads Foucault as a ‘fellow traveller’ (p. 110) of the movement. She convincingly argues that the question of psychic causality figured as a centre of attention to Foucault in his student years at the École Normale and the hospital Saint-Anne, and is further developed in his first book Maladie mentale et personnalité (1954). Crucially, for Robcis, Foucault arrived at a similar conclusion to the institutional psychotherapists, proposing that cure requires the relationship between the individual and its milieu to be intact. The chapter also traces how Foucault mediated exchanges between British antipsychiatrists and the French institutional psychotherapists around Guattari, suggesting that Foucault’s engagement with R. D. Laing’s and David Cooper’s work marked a decisive moment of his intellectual development away from the question of the institution and into the realm of the “disciplinary”.
Despite this recognition of transnational influences and sympathies, Robcis’ book largely remains faithful to the institutional psychotherapists’ own version of history. This is particularly evident in her portraits of British anti-psychiatry, which are partly based on judgments of the “French side”, which deliberately wanted to distance itself quite clearly from its British counterparts, whose work somewhat anticipated institutional psychotherapy, and was in many ways more similar to theirs than they liked to admit.
While the book makes an important contribution to the intellectual history of a neglected movement, it leaves the question of alienation that its title provokes largely untouched. Sure, we learn that ‘… institutional psychotherapy insisted on the role of institutions in the process of alienation and disalienation of the political, the social, and the subjective’ (p. 73), but a historization or discussion of alienation outside of the protagonists’ framework would have been instructive. The question arises whether alienation, for example from fascism, which marked the birth of institutional psychotherapy as a resistance movement, cannot be thought of as a positive and generally desirable experience.
In many ways, the history of institutional psychotherapy is more convincingly communicated through visual materials than words. Readers in New York City can visit a major exhibition about Francesc Tosquelles that includes hours of film and outsider art produced in French institutional psychotherapeutic milieus at the American Folk Art Museum until 23 October 2023.
Janina Klement is a final year PhD student in history of psychiatry at University College London and an affiliated member at the Birkbeck Centre for Interdisciplinary Research on Mental Health.