In order to better situate Foucault in relation to madness, psychiatry, and antipsychiatry it might make sense to briefly look at the particularities of French antipsychiatry. To that end I’ll give a brief history of the French context, which differs so much from other setting in which antipsychiatry would be born. In this post I want to explore the characters and character of the psychiatric hospital Saint Alban. It is this setting that would colour what came later in France’s history of psychiatry, and it is from this place that Institutional Psychotherapy- arguably France’s answer to antipsychiatry- would be born.
First of all it is important to understand that in the French context the term antipsychiatry didn’t appear much. David Reggio has pointed out that in France people tended to speak more of a “different psychiatry” or a “reorientation of psychiatry”. In Reggio’s fascinating presentation to the Antipsychiatry and its legacies conference he is quick to point out that French psychiatry had a different evolution to that of its British or American relatives, those countries where the term “antipsychiatry” really took hold. Unlike the UK or the USA France suffered occupation during the Second World War and this obviously affected the development of psychiatry there.
In 1941 the Vichy government formed a new Ministry of Health and placed a Dr Serge Haurd at its head. The new ministry operated to pass a series of laws that would concentrate power over pharmacy, hospitals and medicine into the hands of the state. Mental health was not high on the new ministry’s concerns. According to Chapireau (2007), some 45,000 inmates of psychiatric institutions died in the period 1939-1945 due to starvation and infectious diseases. This famine didn’t really take effect until 1940, just one year before Haurd’s appointment, and would continue until 1944. The psychiatrists wrote about the conditions in their hospitals but they did so in clinical language so as to avoid censor and recrimination. There are reports cited in Birley (2002) that during the Vichy regime’s lifetime famine and starvation were the single most written about phenomena in the leading psychiatric journal. According to Lemoine (1998) a purposeful reduction of supplies to psychiatric hospitals led to the sky rocketing mortality rate, with his figure of 48,000 deaths caused by the famine. Lemoine went so far as to call the policy one of deliberate ‘soft extermination’, an attempted genocide of the mad, although almost every other source seems to think that Lemoine is going too far with this claim, that this was less an extermination and more a massacre by omission. We could argue that between active slaughter and deliberate mass starvation there isn’t much to separate one extermination from another. Birly goes on to report the existence of ‘The French Foundation for the Study of Human Problems’ since 1941, identifying it as a kind of think-tank that would look into solving the problems of feeble-mindedness, among others, and whose director was a strong advocate of eugenics. Psychiatrists and other workers did attempt to feed their patients by increasing productivity on their own farms, but these were huge institutions with thousands of inmates. Birly reports of one psychiatrist who wrote to the Ministry for additional rations, receieving the reply that
increased rations should only be given to those patients who are likely to recover sufficiently to be discharged and take their place in society.
What does this mean, “take their place in society”? Given that we’re talking about Vichy France in the midst of a war, I think the implications are clear. We should also bear in mind exactly who the Vichy Government supported and were legitimated by. The nazi regime itself was responsible for the active extermination of people with schizophrenia. E Torrey Fuller reports that somewhere between ‘220 000 and 269 500 individuals with schizophrenia were sterilized or killed’ and that this represents between 75-100% of all German schizophrenics. Fuller’s report on the killing of schizophrenics presents us with a systematic genocide of no less horrific industrialisation than was carried out in the murder of 6 million Jews. We must understand that French psychiatry re-emerges from occupation, famine, and war.
There was one notably exception to the grave picture of French psychiatry during the war. At St Alban’s Hospital in the south of France not a single patient died. The St Alban’s hospital had operated not just as a psychiatric hospital but also as a sanctuary for a number of Resistance fighters, conscientious objectors, French intellectuals and surrealist artists. This mixture of therapists, intellectuals, militants and mad people gave St Alban’s a particularly liberated feeling and would help to establish it as a site of autonomy. Indeed David Healy records that the hospital would eventually become a site of ‘pilgrimage’ and that many pilgrims came away with a sense that resistance ‘against tyranny and oppression was not yet over, but had to extended into the rest of bourgeois society’ (2002, 151). To understand the importance of St Alban’s we should ask ourselves whether we could conceive today of a similar situation taking place in a psychiatric hospital- whether in France, the UK, the USA or any other part of the world. Today, to have this kind of situation would be intolerable and forbidden. Psychiatric settings in societies of control are driven by fear, codified as “risk”, and operate on the basis of managing that fear. Better put, we could say that today’s psychiatric institutions are anxious places: there is this fear of the patient, her potential for violence and for self-destruction that in general outweighs the actual likelihood of her carrying such violence out. Today’s hospitals are certainly not hotbeds of militancy and radical action or of intellectual pursuits (I’ve often wondered why not even though the answers are immediately obvious…but under different circumstances: the hospital as the site for the production of embedded intellectuals, a kind of “mad inquiry”). It was only because of the unique circumstances of the war, the necessities it brought with it, and the hospital’s geographical isolation that allowed it to flourish as a zone of militancy.
Opened in 1921 by a Dr Tissot, the hospital had already instituted an open doors policy by 1942. An open doors policy allows psychiatric patients the right to enter and leave the hospital at any time they please, in a move that was purposefully designed to radically curtail the power of psychiatrists over their inmates and to transform those inmates into voluntary patients. In the Italian context Basaglia would begin to do the same at his hospital in Gorizia, and he struggle with the question of this voluntary curtailment of the psychiatrist’s power. Basaglia had some affiliation with Maoist theories of the self-dissolving of power but his anxiety was that if the psychiatrist voluntarily ceded her power this to was an act and so an expression of that same power. If these same concerns arose in St Alban is impossible for me to say, as very little source material has been translated into English (although a book on the subject is in preparation). Certainly Tissot is said to have been inspired by Pinel, the man who “liberated” the inmates of a mental hospital in France and according to one history iinaugurated a new humane psychiatry. We all know what Foucault would have to say about that (for those that don’t, he called bullshit).
Two of the most important psychiatrists to work out of St Alban were Francois Tosquelles and L. Bonnafe. Again, there is not much that has passed into English on what these men wrote, so we largely rely on the reports of others. However, we do have the following transcription of Tosquelles oral description of Tissot:
His discourse resembled that of today’s [1960s] antipsychiatry in many ways. At the time of the creation of St Alban’s , Tissot had some partisans, for example two peasants, Guazi and Rousset; he sent them to Dupuytren in Paris, a guy who was an anti-doctor we would say today, an anti-psychiatrist, because he fought against blood letting, baths, purges, and all those wild therapies psychiatrists used. And this Tissot sent Guazi and Rousset, Lozere peasants, to work for a year at Dupuytren, to learn what could be learnt of therapeutic and clinical value. They were the first two psychiatric nurses of France. Tissot was therefore the anti-psychiatric creator of St Alban’s hospital and of 25 others. All this is a strong current that by far preceded the 1838 law, which was already a way of integrating, of recuperating that anti-psychiatry (cited in Postel and Allen 1994, 399).
So we see Tosquelles citing St Alban’s as an antipsychiatric institution, and its founder as an antipsychiatrist. This is significant coming from the man who was called “the red psychiatrist”, a man who had fought against Franco in the Republican Popular Front in the Spanish Civil. We have been told that antipsychiatry wasn’t spoken much in France, so when it appears we should pay attention. The description of both the institution and the man with this term is more important for it reveals about Tosquelles than it does about St Alban’s or Tissot themselves. We have no way to know is Tissot would have considered himself antipsychiatry, even if it seems clear that St Alban’s could easily be considered to meet with the concerns for the creation of disalienated spaces that would mark the antipsychiatry to come. It also tells us something about the misunderstood name of antipsychiatry. While many people still see in that name something like a total negation of psychiatry, we can see that Tosquelles saw antipsychiatry as a movement that worked to end the abuses of the psychiatric system, its excessive power, and its role in subjecting mad bodies to what amounts to torture. Given this, we can assume that Tosquelles saw himself as part of the same antipsychiatric movement.
Tosquelles arrived in St Alban’s in 1941 and it was under his tenure that the open door policy was put into place there. It was also Tosquelles who oversaw the demolition of the walls around the hospital, by this point renamed a “psychiatric centre”, and the removal of the prison bars from the windows. Before fleeing Spain, Tosquelles had studied Freud, Marx and Reich and, most significantly, had become well versed in Lacanian psychoanalysis. According to Tosquelles himself when he fled Spain he carried with him only two texts, one of which was Lacan’s work on paranoia. In Roudinescu’s (1990, 199) insightful turn of phrase, Tosquelle became convinced of the need to introduce into clinical practice ‘a couchless variant of Freudianism’. Roudinescu also reports that while he had been fighting in Spain, Tosquelles had become convinced that a number of psychoses had resolved themselves spontaneously because the people caught in their grips had become “useful to their comrades”. In other words, the fight against fascism was linked to the psychic condition of militants and thus antifascism could be seen as a moment of political therapeutics. With Toscquelle’s communist antifascism and Lacanianism we also see an early example of Freudo-Marxism coming to France. In fact, Toscquelle’s clinical practice would come to be known as Institutional Psychotherapy and would dominate the French scene. If there is a reason that the French didn’t speak very often of antipsychiatry it is because they spoke instead of Institutional Psychotherapy, which involved a radical reorganisation of the asylum and clinical work.
I don’t think it is possible to stress the heady environment of St Alban or the significance of its milieu, to use a term that would become important in Institutional Psychotherapy. Francois Dosse speaks of an ‘interweaving between the Resistance and the hospital’ (2011, 42), noting that weapons drops for the Resistance had to be organised for around the hospital’s grounds, and that much of its staff were in fact Resistance fighters. The director at the time of Toscquelles arrival, and whom the he would succeed, Bonnafe wrote that central to the hospital was the spirit of ‘continuity and fidelity’ that emerged from a shared experience of resistance to Spanish and German fascism. Among those who would seek refuge or train at St Alban are listed Tristan Tzara, Paul, Franz Fanon (who spent two years training under Toscquelles), Georges Canguilhem (whose discussion of normality and abnormality would be pivotal to Foucault), and Jean Oury. For my purposes here, it is the last of these who stands out among the crowd for the simple reason that Oury would go on to found what is perhaps the most important site in the history of French psychiatry: La Borde. Leaving St Alban for the moment we can conclude in the words of Felix Guattari that it was there ‘a new attitude, a new militant approach to mental illness was born’ (1972, 40).
In the next post in this brief history I’ll have a look at the formation of La Borde, the radical practices that were put in place there and its importance for shaping both French psychiatry and the militant psychiatry that would come. At this point I don’t think that it is at all impertinent or premature to say that without the experience of La Borde there would be no Guattari as we know him, and certainly no Deleuze and Guattari. La Borde would be a revolutionary experiment in psychiatry that would take what was developed at St Alban and go further, fundamentally reorienting the routines, organisation and purpose of the psychiatric institution in France.
Birley, JLT. 2002. Famine: a distant shadow over French psychiatry. Online.
Chapireau, F. 2007. La Mortalite des malades mentaux hospitalises en France pendant La Deeuxieme Guerre Mondiale. Here.
Dosse, F. 2011. Gilles Deleuze and Felix Guattari: Intersecting lives. new york: Columbia University Press.
Guattari, F. 1975. Psychoanalysis and Transversality.
Postel, J., and Allen, D.F. 1994. History and antipsychiatry in France. In: Micale, M.S., and Porter, R. eds. 1994. Discovering the history of psychiatry. Oxford: Oxford University Press. Most of this text is available online.
Roudinesco, R. 1990. Jacques Lacan & Co: A history of psychoanalysis in France, 1925-1985. London: Free Association Books.