Tearing down the walls of Saint-Alban. Film still from Hélène Álvarez Tosquelles and François Tosquelles, Société Lozérienne d’Hygiène Mentale (Lozerien Society of Mental Hygiene), Institut Jean Vigo — Cinémathèque de Perpignan, 1954–57. Courtesy Michel Tosquelles.
Continued from Part 1
The second talk translated in Psychotherapy and Materialism is by Jean Oury. It was originally delivered nearly thirty years after the talk given by Tosquelles and two years after the 1968 uprisings. It is intentionally pragmatic, detailing the inventions of institutional psychotherapy (IP) during the Second World War, during its immediate aftermath, and during his own moment.
Oury argues that it is important to describe the concrete practices, or the “tedium,” through which IP is actualized. Here he clearly looks to the past to argue against the enclosures looming in the post-68 environment, where demands for a radical reworking of everyday life (and madness within it) were at high risk of sedimentation. This was due, on the one hand, to institutionally delimited state modifications, and on the other, to romantic political and philosophical mythologizations, a charge Oury levelled in subsequent years against the writings of Deleuze and Guattari.
Oury’s interest in concrete practices is evidenced by the way he discusses the notion of freedom. In Oury’s treatment of the topic, emerging figures of individual liberation like the vagabond, the artist, the student militant, and (as in Deleuze and Guattari’s “the schizophrenic”) the madman are replaced by a circulatory and collectively articulated freedom navigated through a set of alternative routines, meetings, and groups developed to ensure the movement of people between roles and spaces, inside and outside the clinic. If liberation as elaborated in Deleuze and Guattari’s Anti-Oedipus is to be found in the “schizophrenic taking a walk,” that walk, suggests Oury, must involve the concrete daily organization and reorganization of active life.
Oury’s notion of freedom as traversing the inside and outside of the institution is embodied in his description of La Borde’s patient-run cultural committees, which had control over their own budgets and were part of a network of socio-therapeutic, patient-led groups in clinics across France. These intra- and inter-institutional groups would meet regularly to shape clinic agendas so that participants would not, in Oury’s words, succumb to oedipal “good behavior” paradigms, like they would if the groups were directed by clinic doctors. These committees programed activities for patients, doctors, cooks, and cleaners, and, importantly, curated cultural events and led discussion groups in neighboring communities to reimagine self-governance within the institution. Their social and cultural trajectory traversed architectural and discursive confines, including those of “art therapy” and “outsider art.”
Oury pays particular attention to the way in which the experiments developed at Saint-Alban at once bettered patients’ lives and generated conflicts that served as analyzers of both the internal operation of the clinic and broader social problems: social stratification; the stultification of roles; social blockages created by professionalization, managerialism, and their tendency toward abstraction; and oedipalized systems of reward. He describes how new doctors were asked to do the dishes for a few weeks at the outset of their time at La Borde, attuning them to the reproductive dimensions of the clinic, bringing them into social contact with patients, and countering their inclination to create relations of dependency and self-importance. The conflicts and crises that emerged from such “training” revealed the new doctors’ micro-political investments in the traditional mechanics of their field. The role of “The Club”—the regular meeting of cross-institutional groups—was not simply to foster institutional reform or “change from within,” but to tear down the various institutional enclosures that constitute madness—spatial, social, political.
Though Oury’s 1970 talk contains none of the explicit Marxist language found in Tosquelles’s earlier talk, and even emphatically declares its distance from communism, his discussion of the articulation of conflict and contradiction reveals the ongoing influence of the Marxist dialectic on IP. Oury’s talk is particularly useful for problematizing the current way in which solutions in the field of care are so rarely connected to the concrete circumstances, constituencies, and modes of articulation from which problems emerge.
Oury gives an important example from his own time of this insufficient attention to the concrete. In the years following the early experiments at La Borde, its ideas of social circulation were “scaled up” by architects and care planners: they designed, at great expense, social spaces in hospitals that went entirely unused by patients. This demonstrates that what is needed is a mode of micropolitical attention that unlocks the contradiction between relationality as illness and relationality as a potential that generates a therapeutic praxis. As the translators of Oury’s text, Anthony Faramelli and Marlon Miguel, point out, the French word “soigner” is not limited to the connotations of the anglophone term “care” (i.e., treatment), but can also mean “the practice of (collectively) paying attention.”
The dialectic as a mode of attending serves here as a kind of aesthetic education (to use Gayatri Spivak’s term), intervening into “epistemic performances” of care that are rooted in both the micro-fascisms of French bureaucracy and the recuperative modifications abstracted from the social critique looming on the neoliberal horizon.
That said, the status of the dialectic is not wholly resolved in Oury’s talk. The question of wage distribution in radical clinics like La Borde is a key example of this. While roles in the clinic were reversed and doctors often spent as much time in the kitchen as in diagnostic care, the wages of doctors, nurses, orderlies, and residents (many of whom received private money or were on minimal social assistance) were not socialized or redistributed. This structurally reinscribed institutional verticalities, which were otherwise challenged within the clinics’ various groups and committees. Oury suggests that discussions and debates at the regular weekly meetings of The Club analyzed social relations within the clinic that were born of the contradictions of capitalism and its role in the production of illness. But without concretely confronting the question of wage redistribution, one wonders how radical the experiment in professional re-subjectivation really was at the clinic—a question that still occupies clinics practicing social therapy today. Tensions between Marxism, anarchism, and psychoanalysis remain constitutive and unresolved in IP, which we can understand not as a solution or as a method but as a practice in tension that is as-yet-incomplete.
Fault Lines Today
Reading IP conjuncturally as a response to two previous moments of fascism—one its overt mode at the height of Nazism, and the second its covert and emergent mode in the post-68 restoration of the capitalist order—we are brought to our own moment, in which remnants of both are palpably felt.
How do these histories of IP inform our current contentions with fascism as they intersect with practices of care? We live in a moment in which few trade-union movements, for example, have made transversal solidarity their aim, or have made permeable the relation between classes, places of work, and wider social justice. How might the histories of IP help us reconfigure the contradictions that shape our collective movement work, moving us from shame and failure to spaces of analysis? How do we treat collective breakdowns not as the end but the beginning of a process where libidinal drives and psychic resistances might be generatively examined? In universities, where histories of IP are often engaged, how can an intellectual class that has turned to individualized self-care and self-promotion for solace in the face of a debt-ridden corruption machine they are tethered to instead support what James Boggs called the “self-governance” of lumpen communities, who are the target of overt and implicit fascisms?
This is where the question of militancy, which lies at the heart of this small collection of texts, becomes crucially important: not as a program of activity or as prescriptive jargon, but as a commitment to a simultaneously theoretical and pragmatic approach to psychic, structural, and conjunctural contradictions.
Here the book’s own contradictions come to the fore. For one, it privileges the proper names of two physician-philosophers while describing IP as a polyvocal, de-professionalizing, and radically relational practices. How does this reproduce the very segmentation that IP aims to abolish? I do not mean to call for “lived experience,” which often reinforces the marginalization and individuation that structure the semiotic conditions of madness. Rather, I mean to pose a question about how we can attune ourselves to the enunciative forms that the collective takes on when its attempts to negotiate difference, contradiction, and conflict. How might they perturb the language rituals of both the clinic and the academy? This is a problem not easily surmounted, since we access the history of IP through those who had the means, status, and opportunity to write about it. Not all practices of segregation were surmounted in IP after all.
Tosquelles himself was aware of this conundrum. In a 1985 interview conducted by François Pain, Jean-Claude Polack, and Danielle Sivadon, Tosquelles was asked about his exceptional contribution to Saint-Alban. “I’m an enemy of this personalization,” he replied. (Video clips of this interview are featured in Mireia Sallarès’s 2021 film about Saint-Alban, Potential History of Francesc Tosquelles, Catalonia and Fear). Instead of talking about his own contribution, Tosquelles continues by telling a story about the many workers and patients who, together, invented the practices of IP at Saint-Alban. He mentions a nun who wanted to humanize the asylum by abolishing straightjackets. When the nurses resisted this, she told them to wear a straightjacket for a week until they understood the nature of the institutional alienation imposed on the ill. This is a crucial lesson about how the processual and multiauthored praxes of IP unfolded over time and space.
Small details in Psychotherapy and Materialism—like stills from video footage of the Société Lozérienne d’Hygiène Mentale (Lozerien Society of Mental Hygiene) taken by Hélène Álvarez Tosquelles and François Tosquelles, and references to the collective construction of a wall at Saint-Alban—hint at a desire to speak and narrate collectivity in its human and nonhuman material dimensions. “Even the camera is part of the collective construction,” says one citation. In their introduction, Miguel and Vogman acknowledge that many practitioners who contributed to La Borde are missing from the two talks by Tosquelles and Oury. Whereas publications from, for example, democratic psychiatry movements in Trieste include reflections by doctors alongside less orthodox forms of patient and worker writing (as does Jean Khalfa’s recent translation of Fanon’s psychiatric writings), here were are given less insight into how such disparate modes of articulation take material and semiotic form.
The question of proper names also relates to the telling of IP histories. How do we avoid the lure of archive fever and nostalgia, or worse, academic and publishing conventions that valorization individual prowess, academic ego fulfilment, and intellectual market positioning rather than the reignition of non-segregationist, transversal forms of organizing? How might the compulsions to territorialize knowledge in the present become analyzers of our own “segregationist” tendencies? How do the ways we write and record the histories of such movements instigate what autonomous, militant care might look like today? The important work of suturing radical histories of care to the present must keep these tensions in mind, using them as the basis for the development of historical consciousness and for continuing the struggle against fascisms in their most infantile and pronounced forms.
This brings us to a final tension in the book: whether the practices discussed in it are the institutional tinkerings of professionals, or contributions to a more revolutionary project of dis-alienation. In his Survival of Capitalism, Henri Lefebvre suggests a spectrum of militant praxis ranging from the minimal—working to solve the contradictions posed by capital at the level of social relations in order to produce “coherence”—to the maximal—working through contradiction toward the disappearance of all forms of institutional alienation: labor, the family, the state, and, importantly for our time, the individual.
Different moments in the history of IP fall into different parts of this spectrum. Though at times this book reads like a guide for psychiatric innovations, the conjunctural positioning of Tosquelles and Oury reminds us of the role that Saint-Alban and La Borde played in the French Resistance and May 1968, respectively. In the psychiatric writings of Frantz Fanon, as compiled by Jean Khalfa and Alice Cherki, we see how IP, when working within and alongside revolutionary struggle, diagnosed the micro- and macro-dimensions of authority and subordination. Having spent time at Saint-Alban with Tosquelles, Fanon and his colleagues altered the life of the Blida Joinville Clinic in North Africa during the anti-colonial struggles of the 1950s. In recent films, writings, and excerpts from journals written by Fanon, doctors, orderlies, nurses, and patients at Blida Joinville, we see how IP praxes can be attached to wider movements and how a professional class of workers can defect and redeploy themselves in solidarity with militants, the mad, and the nonnormative. Most profound in these texts is the way in which Fanon and his colleagues both hold and potentiate the dialectical contexts of colonial war, supporting (by harboring) fighters from the FLN while at the same time “treating” the local chief of police, whose sadistic tendencies extend from the violence of counterinsurgency into the domestic realm. While instituting practices of care by disrupting segregation, carceral logics, and professional identification, Fanon and his colleague Jacques Azoulay began from the contradictions in their own importation of concepts and practices from France: the practices of IP—the club, activity workshops, etc.—that worked well with white, European women did not work well with Arab men. This incited Fanon and his colleagues to reflect on the institution of colonialism and to begin a practice of listening and research with local people about the social modes through which they “thought” madness. It was his understanding of the desiring mechanics of the well-intended professional, and of the patriarchal and nationalist tendencies of the occupier, that led Fanon to alert revolutionaries to what remained of these elements in the nationalist aftermath of anti-colonial struggle.
The question remains: How do we produce movements that do not merely accommodate the lumpen, the poor, the medicalized, and those charged with their care, but instead begin with forming alliances with these groups? How do we generate modes of enunciation that work from structural, conjunctural, psychic, and institutional analyses?
The practices (and contradictions) described in Psychotherapy and Materialism give us some insight into how to support the self-governance of “surplus” communities, how to attend to both “tedium” and contradiction in the formation of non-carceral approaches to care, how to work through tensions between the anarchist impulse to abolish institutional hierarchy and the Marxist commitment to the collective analysis of social contradiction, and how to join in enunciative forms of solidarity with the protagonists of our historical moment.
Today, our colleagues are thrown into unmarked vans for participating in pro-Palestine demonstrations on US campuses, while the UK government equates well-being with eugenicist definitions of “productive” labor. This is the legacy of the history experienced by practitioners of IP, whose caring and coordinated militancy we desperately need to revive and rework.
Recent calls for better figureheads, universal principles, and correctly articulated moralities are beside the point. Rather, what is crucial are questions of listening, working alongside, and becoming attuned to how our conjuncture shapes segregationism in our collective desires and instruments—as is linking this attunement to work against the structural dimensions of capitalism that continue to facilitate material and psychic subordination. Failure to do so will leave our movements ill-equipped to fight fascisms in all their forms.
