By examining four figures in institutional psychotherapy, Camille Robcis traces the history of a movement that combined psychology and politics in its practices and reflections.
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Camille Robcis's second book is grounded in a question whose topicality the author emphasises from the outset: "to what extent can the central concepts of institutional psychotherapy [...] be useful to us today in understanding the persistence of extreme right-wing movements, of real and internalised fascisms 'in our heads', which continue to thrive and spread throughout the world?" As a historian and specialist in contemporary French thought, Camille Robcis also intends to look at the uses and extensions of the ideas she studies: this is undoubtedly the major challenge and central interest of her latest book.
Institutional psychotherapy emerged in France after the Second World War. Its theoretical foundations lie in the work of Marx as well as Freud, and it aims to disalienate the psychiatric institution as well as the subjectivities involved. Camille Robcis traces the history of this movement, from the elaboration of its theoretical foundations by François Tosquelles to the transformations imposed on it by Félix Guattari's institutional analysis, via Frantz Fanon's transnational appropriations and the distant companionship of Michel Foucault.
The challenges of this presentation are at least twofold. On the one hand, it offers a political history of a movement that subverts the thematic and geographical frameworks generally used to study French Theory. On the other hand, it is also about "thinking with" these authors and presenting critical tools that can be used to interrogate and unmask fascist investments in their most everyday and contemporary forms.
Transcultural constellations
Camille Robcis aims to capture the theoretical and practical developments of institutional psychotherapy by studying a number of key figures. Each chapter of the book is organised around one of these figures, whose sequence is not so much chronological as thematic and contextual. By analogy with the notion of "transferential constellation", by which Jean Oury refers to the collective nature of psychoanalytic transference, Fanon, Guattari and Foucault can thus be understood as a "constellation" of authors gravitating around Tosquelles's founding intuitions, adjusting them to a specific context.
These intuitions are themselves the product of a particular conjuncture, characterised by political militancy, the historical experience of fascism and transnational exchanges. It was in 1939 that Tosquelles, a Marxist activist and Catalan psychiatrist, arrived in France with a stream of exiles from the Spanish Civil War. He put his clinical experience at the service of refugees parked in concentration camps, before being called by Paul Balvet to the psychiatric hospital at Saint-Alban in Lozère. It was here that the foundations of institutional psychotherapy were laid.
At Saint-Alban, Tosquelles was convinced of the indissoluble link between psychological and political alienation. Theoretically, this conviction was fuelled by the thesis of the German psychiatrist Hermann Simon, according to which patients must first be cared for by caring for the institution, and by that of Lacan, who had been able to bring to light the multifactorial nature of psychoses. But it was also supported in practice by the experiments carried out at Saint-Alban. Tosquelles and Balvet were seeking to improve patients' living conditions in a context where psychiatry was bled dry. To achieve this, they opened up the hospital to local life and organised a range of activities (meetings, occupational therapy workshops, events, outings), the benefits of which were both material and therapeutic. By breaking down walls and boundaries, the psychiatric institution becomes a place for collective experimentation that benefits both patients and democratic life.
By emphasising the importance of the various forms of transfer, exchange and encounter that originally underpinned institutional psychotherapy, Camille Robcis provides a key to the history she proposes. This explains the hypothesis that "Fanon was perhaps the most faithful reader of institutional psychotherapy when he had to adapt the lessons of Saint-Alban and 'deterritorialise' them for the colonial context of Blida". Faced with the combined experiences of racism and colonialism, Fanon sought to adjust the therapeutic frameworks set up at Saint-Alban to the "national culture" of the Algerian and Tunisian patients in his care. This adaptation had to resist both an indigenist essentialism focused on the past and the application of an abstract universalism whose pathogenic effects Fanon revealed. For him, it was a question of historicising cultural and racial categories and adapting the clinic to the local population. But it was also about revealing the devastating effects of colonialism in the aetiology of psychoses.
It was in a similar spirit that Guattari, sensitive to the unconscious structuring of reactionary themes, called for the "deterritorialisation" of the unconscious. While Fanon's and Guattari's understanding and appropriations of institutional psychotherapy are not strictly equivalent, they do make it possible, through these cultural and contextual variations, to grasp its spirit.
According to Camille Robcis, this spirit consists of "an ethic, a form of life and thought" that is irreducible to a supposedly stabilised doctrinal content. It is therefore by virtue of the very definition of institutional psychotherapy that the "dialogical" approach to texts and practices proves its effectiveness. From a historiographical point of view, the first result of this method is that it forces us to "decolonise" intellectual history. But it also makes it possible to re-establish the unity of institutional psychotherapy on the basis of the figures who have helped to define and practise it in different cultures and contexts.
The politics of psychiatry and psyche
An essential dimension of the psychotherapeutic "ethic" that Camille Robcis seeks to identify lies in the uncovering of a profound interaction between the psychic and the political. This guiding principle appears to be common to the theoretical and practical work of Tosquelles, Fanon, Guattari and Foucault. However, there are two aspects to it, which are developed differently in each of these perspectives. On the one hand, institutional psychotherapy seeks to use the collective dimension of the institution for therapeutic purposes: in this sense, it is akin to an authentic "politics of psychiatry". But it also aims to shed light on subjectivity from the historical, social and political coordinates that contribute to its structuring: this is why it can also be seen as a politics of the psyche.
Following a purely therapeutic path, institutional psychotherapy aims to reshape the institution in order to break down its hierarchies and open it up to the outside world. Most of the innovations introduced at Saint-Alban were designed to achieve these two aims. This was particularly true of the elimination of regulatory dress, which tended to confine doctors and patients to "fixed roles". This disruption of institutional structures also involved architectural changes, starting with the demolition of the asylum's walls. In short, for the promoters of institutional psychotherapy, it was a question of producing a disalienation in action that should have psychic effects. This explains the historical affinities between institutional psychotherapy and the desalienation movement, which led to the sectorisation of French psychiatry. In both cases, the opening up of hospitals appears to be congruent with the desire to undermine the hierarchies inherent in institutions whose concentrationist excesses Tosquelles perceived.
The alienating effects of authoritarianism are thus self-evident to the promoters of institutional psychotherapy, and the theoretical basis of their clinic is a consideration of the social aetiology of psychoses. More precisely, without reducing madness to a social construct, institutional psychotherapy questions the factors — not only neurological and genetic, but also historical and political — that jointly contribute to psychic structuring.
This stance against reductionist psychiatry is informed by the writings of Marx and Freud, the "two legs" of institutional psychotherapy, to use an expression dear to Tosquelles. They shed light on the interaction between social and mental alienation. In this respect, Camille Robcis carefully distinguishes the institutional perspective from anti-psychiatric theories, which tend to deny the very reality of mental illness.
In contrast to both neurobiology and anti-psychiatry, the author sets out to define the specificity of institutional psychotherapy, for which "neurological, unconscious, familial and social factors are in constant interaction in the construction of the self". In so doing, institutional psychotherapy contributes to the clarification of normal as well as sick subjectivity: in so doing, it follows Canguilhem's intuitions and acknowledges the blurring of the boundaries between the normal and the pathological.
It is by virtue of this attenuation, and of taking into account the coextension of the psyche and the social field, that the particular trajectories of Guattari and Foucault can be envisaged. What is at stake in Guattari's transformation of institutional psychotherapy is both a broadening and an internalization: a broadening of its field of application, but also an internalization of the fascism to be combated. By working with Deleuze to develop a "schizo-analysis" aimed at bringing to light the libidinal investment of the social field, Guattari opened the way to an "institutional analysis" that was destined to extend beyond the therapeutic field alone.
The place assigned to Foucault in the author's genealogy is also illuminated in the light of this social and political construction of subjectivity. Although Foucault was only distantly associated with the circles of institutional psychotherapy, Camille Robcis provides a convincing analysis of the role played by his early work on psychiatry and the anti-psychiatric reception of the History of Insanity in the reformulation of his conception of power. Foucault sought to show how relationships of power wove their way through the relations between doctors and patients, and welcomed the efforts of "anti-psychiatry" (which in his view included the Guattarian enterprise) to expose and dismantle these relationships.
Foucauldian qualification of Deleuze and Guattari's work in terms of an "ethic" as an "introduction to the non-fascist life" is thus understandable. Guattari's undertaking, like Foucault's, gives a new meaning to the ethics of institutional psychotherapy: if the latter does indeed constitute "a form of life and thought", it also engages in a critical relationship with the unconscious determinations that knot together the relationship between the psychic and the political.
Psychoanalysis and psychiatry
The attention that institutional psychotherapy pays to psychoanalytical research goes hand in hand with a concern to understand the political coordinates of the psyche. Institutional psychotherapy breaks away from traditional psychiatry in its ability to bring transference and the analysis of fantasies into play on an institutional scale: its aim is to "integrate one with the other" the fields of psychiatry and psychoanalysis.
If Lacan's reading of Freud appears important, it is because it allows psychosis to be referred to a personality structure that must be considered in relation to an unconscious order. In so doing, Lacan breaks with the strictly somatic explanation of mental illness, but he also initiates a questioning of the dual relationship that standardises the analytic experience in Freud. This is what enables Camille Robcis to specify the project of institutional psychotherapy, the intention of which, she tells us, "was to take the 'return to Freud' begun by Lacan a step further and see how psychoanalysis could be useful to psychotic patients in a hospital setting rather than in face-to-face sessions". The use and transformation of Lacanian concepts thus form a common thread running through its history, which also helps to distinguish its various protagonists.
Although the importance of the Lacanian reference can already be seen in Tosquelles, who contributed to its dissemination in France, it was in the institutional psychotherapy practised at La Borde that this reference was most exploited — but also most contested. Jean Oury founded the La Borde clinic in the Loir-et-Cher region of France on the basis of the Saint-Alban experience, but he re-examined the frameworks that organised collective life in the light of Lacanian concepts. These frameworks are seen as spaces for transfers, enabling group fantasies to be analysed and unravelled at the same time.
Camille Robcis stresses the importance of the Lacanian triad of the Real, the Imaginary and the Symbolic in thematising the fixation of subjects on predefined identities. Yet it is precisely in order to counter such identifications and encourage the production of new subjectivities that Guattari, in his critical enterprise, calls into question a certain number of Lacanian categories. Camille Robcis shows that in Anti-Œdipus, Deleuze and Guattari attack both the Freudian understanding of psychosis and Lacanian structuralism. In both cases, they point to an unsatisfactory study of desire. It is by understanding desire in its productive dimension, they argue, that we can account for the desirability of fascism and free ourselves from an internalized authoritarianism.
The redefinition of the relationship between psychoanalysis and psychiatry underpins the book's conclusion, which is "an invitation to take the unconscious seriously in political matters, to bear in mind its social dimension and [...] to continue inventing new political imaginaries and new commonalities". It is sometimes regrettable that Camille Robcis sacrifices certain detailed analyses in favour of an overall apprehension of the "ethics" she seeks to define. These minor shortcuts do not, however, betray the thinking of the authors studied: on the contrary, they invite us to take a closer look at the work they have undertaken, to deepen or even extend it. This is also what Camille Robcis calls for when she defines institutional psychotherapy as a "laboratory for political invention".
