Disalienation

Politics, Philosophy, and Radical Psychiatry in Postwar France

Camille Robcis

• Publisher: University of Chicago Press
• Year: 2021
• Print ISBN: 9780226777740, 9780226777603
• eBook ISBN: 9780226777887
• Topic: History
• Subtopic: French History
• Index: History

From 1940 to 1945, forty thousand patients died in French psychiatric hospitals. The Vichy regime's "soft extermination" let patients die of cold, starvation, or lack of care. But in Saint-Alban-sur-Limagnole, a small village in central France, one psychiatric hospital attempted to resist. Hoarding food with the help of the local population, the staff not only worked to keep patients alive but began to rethink the practical and theoretical bases of psychiatric care. The movement that began at Saint-Alban came to be known as institutional psychotherapy and would go on to have a profound influence on postwar French thought.

In Disalienation, Camille Robcis grapples with the historical, intellectual, and psychiatric meaning of the ethics articulated at Saint-Alban by exploring the movement's key thinkers, including François Tosquelles, Frantz Fanon, Félix Guattari, and Michel Foucault. Anchored in the history of one hospital, Robcis's study draws on a wide geographic context—revolutionary Spain, occupied France, colonial Algeria, and beyond—and charts the movement's place within a broad political-economic landscape, from fascism to Stalinism to postwar capitalism.

Chapter 1

François Tosquelles, Saint-Alban, and the Invention of Institutional Psychotherapy

Institutional psychotherapy was born during the Second World War in a small and remote village in central France called Saint-Alban-sur-Limagnole. Since 1821, the castle of Saint-Alban had served as an asylum for the Lozère region, housing approximately six hundred patients by the turn of the century (fig. 1.1). Managed by administrators who were, according to the testimony of Marius Bonnet, a nurse who arrived at Saint-Alban in 1931, more interested in “minimizing costs and troubles” than in the welfare of the patients, the asylum slowly deteriorated.1 Without heat, drugs, and basic sanitation, the inhabitants of the Saint-Alban asylum lived in miserable conditions.2 As Bonnet recalls, the patients slept in haystacks that also served as their toilets, amongst screams, foul smells, chronic illness, and death. They were “constantly locked up, day and night, without electricity, in complete inactivity, without ever seeing the doctor” or anyone else from the outside world, since visits were forbidden.3 In 1914 a fire destroyed much of the building, and in 1936 a typhoid epidemic ravaged the institution. Both crises highlighted the pressing need to modernize the insalubrious facilities and to implement serious hygienic measures.4 This was the context in which Paul Balvet assumed the directorship of the asylum, which, in 1937, was declared a psychiatric hospital. It was also the context in which François Tosquelles, one of the most important theorizers and practitioners of institutional psychotherapy, arrived at Saint-Alban, where he worked from 1940 to 1962.

This chapter focuses on the life, the ideas, and the work of François Tosquelles, who had a decisive influence on various of the other figures who appear in this book, including Jean Oury, Félix Guattari, Lucien Bonnafé, Frantz Fanon, and Georges Canguilhem. More specifically, this chapter makes two arguments. First, I want to suggest that Tosquelles played a key role in the dialogue between psychoanalysis and psychiatry in twentieth-century France. Tosquelles brought many of the insights of Freud and especially of Lacan to the domain of psychiatry, both in his theoretical writings and in his medical practice. Tosquelles’s reliance on psychoanalysis revealed the constraints of biological and neurological essentialism in psychiatry. It also exposed the theoretical limits of Freud’s own understanding of psychoanalysis as a departure from psychiatry and as a treatment geared primarily toward neurotics as opposed to psychotics for whom repression, symptoms, language—and hence transference—operated quite differently.5

1.1 Postcard of the Saint-Alban Hospital before the war

© Association Culturelle SACPI

The second argument that I wish to develop in this chapter is that Tosquelles’s psychiatric work was fundamentally shaped by his activism in radical politics in Catalonia and by his experience during the Spanish Civil War, first as a doctor for the Republican army at the front and later as a refugee in a French concentration camp. This experience of physical occupation—whether this occupation came in the form of Spanish nationalism, Stalinism, Fascism, Vichy, or World War II—convinced Tosquelles of the intimate link between political and psychic oppression, between political and psychic freedom. Consequently, politics and psychiatry needed to work together to “disalienate” subjects and “disoccupy” their minds. Marx and Freud were thus complementary figures for Tosquelles, the two sides of one same struggle in what he called a “politics of madness” (une politique de la folie). Whereas Marx was necessary to grasp social alienation, Freud was essential for diagnosing psychic disaffection.6 As Tosquelles explained in a 1984 interview: “From age ten, I already knew what I wanted to do: bring Freud to the asylum, and bring psychoanalysis to the patients. Later, I understood that without Marx, a psychiatrist is nothing. Marx talks about the problems of man as a social being and Freud talks about the psychopathology of man, why he is condemned to suffer. Without them, we cannot understand anything about man, let alone about the mad. This is what all these biological psychiatrists refuse to understand when they think that they can cure the world with a pill.”7 It is this process of bringing together the theories of Freud and Marx and applying them to the asylum that I explore in this chapter.

Marx and Freud in Catalonia

Marx and Freud were indeed the two most important references for Tosquelles before he left Spain and sought refuge in France in 1939. Born in 1912 in Reus, a city south of Barcelona, Tosquelles was deeply marked by the Catalan political and cultural effervescence of the turn of the century. With the electoral victory of the ERC (Esquerra Republicana de Catalunya), which advocated socialism and Catalan independence, Catalonia became the first region of Spain to proclaim itself a republic in 1931. These were vibrant years for the labor movement, which was marked by strong anarchist and syndicalist currents.8 The CNT (Confederación Nacional del Trabajo), founded in Barcelona in 1910, anchored itself in the important neighborhood-based sociability and reciprocity networks that had emerged in the last decades of the nineteenth century. Significant philosophical and tactical disagreements divided the myriad workers’ collectives during these years, but many on the left bonded over their disillusion with the PCE (Partido Comunista Español), the official communist party, which they perceived as too subservient to Moscow, too eager to accept integration and centralization. Instead, the CNT and many groups on the radical left advocated federalism and decentralization, worker solidarity and self-management, and consciousness-raising, particularly through culture.9

In 1935, activists from two of these subgroups, the ICE (Izquierda Comunista de España) and the BOC (Bloque Obrero y Campesino) under the leadership of Andreu Nin and Joaquín Maurín, founded the POUM (Partido Obrero de Unificación Marxista). Nin and Maurín, who had both begun their political activism within the CNT, embraced its vision of society as federated communes. Having traveled to Russia, both were also very much attracted to the thought of Leon Trotsky and his idea of permanent revolution. Most important, the POUM supporters were adamant about their opposition to Stalinism and to the centralized, antidemocratic, authoritarian, and bureaucratic turn that the Soviet Union had taken.10 As its leaders stated in a 1936 manifesto “Who Is the POUM and What Does It Want?,” the POUM fought for “a revolution committed to democratic-socialist ideals, workers’ alliances, the recognition of regional nationalisms and the creation of an Iberian Union of Socialist Republics that would replace the centralized nation, and the right to criticize the policies of the leaders of the USSR when they were counterproductive for the march of the world revolution.”11

The POUM’s advocacy of federalism, regionalism, and anti-authoritarianism clashed with the Comintern’s directives for socialist movements throughout Europe and with Stalin’s foreign policy, which had become increasingly obsessed with the notion of sabotage and treachery after successive defeats in Germany, Estonia, Bulgaria, and China throughout the 1920s. As the POUM’s leaders reiterated, Stalin’s Comintern was a perfect example of ideological colonialism, a “grotesque attempt to impose the map of Russia over that of Spain.”12 Although Stalin immediately denounced the POUM as a “Trotskyite organization” filled with “fascist spies,” the POUM eventually broke with Trotsky who, in their eyes, also sought to force a Russian framework onto Spain. The POUM thus refused to adhere to Trotsky’s Fourth International, preferring to remain politically independent. It is this spirit of critique that pushed the POUM to stand alone amongst international leftist organizations in denouncing the Moscow show trials, and in particular the execution of Lev Kamenev and Grigori Zinoviev in 1936.13

Tosquelles was among the founding members of the POUM, which, by 1936, had grown larger than the official Communist Party of Spain (PCE).14 Fiercely loyal to Stalin and the Comintern, the PCE quickly began calling for the extermination of the POUM. Although the POUM was apprehensive about the strategy of “popular fronts” advocated by Stalin, it chose to participate in the Spanish Popular Front of Manuel Azaña, which gathered republicans, communists, and socialists. The Spanish Popular Front eventually won the elections of February 1936, five months before Francisco Franco’s coup d’état in July 1936 and the beginning of the Spanish Civil War. As Tosquelles recalled in an interview, it was his activism in the POUM that taught him to refuse the “all-power” (le tout-pouvoir). As he put it, “Stalin wanted the POUM to join Madrid and to spread Spanish propaganda—with the monarchy, the military in power—and say ‘all-power-to-the Soviets.’ No republicans, no anarchists, no socialists, nothing.” To accept centralization was to accept to speak castellano “when the Castilians are our oppressors.”15 It was through his activism in the POUM and through his exposure to Catalan anarchism that Tosquelles became especially interested in promoting decentralization, self-management, and solidarity within the confines of the psychiatric hospital, as mechanisms to prevent authoritarianism, reification, and stagnation.

Parallel to his political activism, Tosquelles began medical school in 1927 and chose to specialize in psychiatry, a booming field in the Catalonia of the early twentieth century. As the historian of psychiatry Josep Comelles has suggested, psychiatric reform was central to the Catalanist political project during these years, especially once the nationalists were able to gain control of the four provincial governments of Catalonia between 1914 and 1925. Catalan “psychiatric nationalism,” to use Comelles’s expression, was premised on the idea that individual subjectivity and social communities were conceptually analogous, and thus, that psychiatric care needed to be adapted to the Catalan regional specificity.16 Between 1911 and 1925, one of the government’s main structural initiatives was to decentralize psychiatric care through the implementation of district divisions known as comarcas. The idea behind these comarcas was to allow patients who did not require hospitalization to continue living with their families, in their usual surroundings.17 As Félix Martí Ibáñez, an anarchist psychiatrist who became director of the health and social services of Catalonia after the 1936 Revolution, put it:

In view of the special structure of Catalonia, we chose the comarca, which in this region possesses well-defined geographic and economic characteristics and, because it represents an unheard-of abundance of creative energy and new vitality, it could renew so much of the archaic health care system. We were persuaded that the form of the future revolutionary social organization would be the comarca. In the new Catalan anatomy, it will enjoy a new flowering of life, it will be a palpitating organ in the regional whole, and its warmth will expand the great comarcal capitals which will become the cultural and economic mirrors of the comarca reflected in them, instead of the way things were in the past, when these cities were socioeconomic deserts of little vitality in which, from time to time, an oasis bloomed with false splendor.18

In many ways, the comarca system laid the foundations for what would later be called in France psychiatrie de secteur, a movement that Tosquelles and his associates first developed at Saint-Alban and that was eventually adopted by the French Ministry of Health and generalized to the rest of the national territory after 1960.

Among the most important actors in this Catalan psychiatric reform movement of the early twentieth century was Tosquelles’s mentor, Emilio Mira y López.19 Like Tosquelles, Mira was actively involved in leftist politics, and he was one of the founders of the Catalan-Balearic Communist Federation. But Mira was also a psychiatrist who worked at the Institut Pere Mata in Tosquelles’s hometown, Reus (fig. 1.2). Tosquelles, who was already well acquainted with the Pere Mata clinic through his uncle, who was also a doctor there, joined the medical team soon after finishing medical school. Mira, who was a prolific writer and who held the first chair of psychiatry at the Uni...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Illustrations
• List of Abbreviations
• Introduction: A Politics of Madness
• 1: François Tosquelles, Saint-Alban, and the Invention of Institutional Psychotherapy
• 2: Frantz Fanon, the Pathologies of Freedom, and the Decolonization of Institutional Psychotherapy
• 3: Félix Guattari, La Borde, and the Search for Anti-oedipal Politics
• 4: Michel Foucault, Psychiatry, Antipsychiatry, and Power
• Epilogue: The Hospital as a Laboratory of Political Invention
• Acknowledgments
• Notes
• Bibliography
• Index