Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France

The history of Western psychiatry has been troubled and tragic. Psychiatric knowledge remains riddled with gaps where one would expect to find explanations of the underlying mechanisms of mental distress. Instead of inducing professional humility, this persisting ignorance often has been met with hubris on the part of psychiatrists. The hubris has spawned wanton experimentation, callous disregard, and aggressive “treatments”—most infamously, lobotomy and electroconvulsive therapy. In short, psychiatric history abounds with hard lessons about what should not be done to ameliorate mental distress.Within this dark history of snake pits and ice picks, however, reside counter- histories of alternative ideas, of roads less traveled that may lead to saner destinations. After all, a profession so prone to experimentation is bound to hit on something, sometime. (A broken clock is correct twice a day, right?) Excavating these promising ideas could help us get beyond the paralysis in our contemporary debates, which have polarized into camps of brash scientism, on one side, and antipsychiatry sentiment, on the other.Or perhaps we need a global conflagration to jolt us out our rut. In Disalienation, Robcis tells the story of how the German occupation of France during World War II spurred French psychiatrists to reimagine the mental hospital. Their inspired visions were given the colorless name “institutional psychotherapy.” Its humble origins were in Saint-Alban-sur-Limagnole, an isolated village in central France. During the occupation, the Vichy government indulged the genocidal impulses of Nazism by embracing “soft extermination.” Rather than kill those institutionalized in France's mental hospitals, they would simply let patients die of cold, starvation, and neglect. Saint-Alban's staff refused to cooperate with this policy and worked with the local community to keep their patients alive. In the process, the staff fundamentally rethought institutionalized psychiatric care.The concrete elements of institutional psychotherapy—group therapies, community meetings, a patient newspaper, and a range of cultural activities—were hardly revolutionary. Nor did its ideas ever quite cohere into a fixed dogma or a practical blueprint. Rather, institutional psychotherapy is best thought of as an orientation, or as Robcis puts it, “an ‘ethics’ in Michel Foucault's sense of the term—a practice of everyday life.” This orientation was radically nonhierarchical and profoundly communal. Patients took an active role in running the hospital, and decisions were reached through collective deliberation. The orientation was, moreover, deeply political. Participation in running the hospital was to mirror broader political organization. The goal was nothing less than combating fascism (or “concentrationism”) of the mind. The hospital became a model for a better society and a vehicle to fight the dark forces that had unleashed the Second World War.The reach of institutional psychotherapy remained limited, an interesting curiosity counterposed to Western psychiatry's dominant thrust. Beyond the benefits to the fortunate patients who happened to find themselves in one of the few institutions that adopted its tenets, its true legacy lies mainly in its intellectual influence. Tracing the evolution of institutional psychotherapy between 1945 and 1975, Robcis reveals its significant impact on, among others, two of the twentieth century's important thinkers on psychiatry, Frantz Fanon and Michel Foucault. Underlying institutional psychotherapy was a view of mental distress that emphasized its fundamentally social character. Trauma, grief, suffering, and alienation are psychic states produced by social conditions. Madness is never just a personal affair. The path to “disalienation” is found in the collective vitality of communities and the liberatory politics they pursue. Robcis draws a through line from these ideas to Fanon, who was a medical resident at Saint-Albans and developed his own incisive account of the madness induced by colonialism. Less directly, institutional psychotherapy inspired Foucault's intellectual program of using psychological discourse as means to theorize power.Whether institutional psychotherapy has more yet to offer us remains to be seen. Saint-Albans has moved on, and its influence elsewhere is tenuous at best. Out of professional arrogance, some psychiatrists balk at its more democratic form of care. At the same time, institutional psychotherapy is unpalatable to the more vocal critics of psychiatric institutionalization. The stance of institutional psychotherapy lacks the anti of antipsychiatry. But even so, the central message of institutional psychotherapy—that mental distress and its proper treatment are always political—remains a vital insight. Robcis's book accomplishes many wonderful things, but at its most basic, it keeps the flame of institutional psychotherapy burning. Too often our debates over psychiatry arrive at endpoints that can seem inevitable. Robcis's history reminds us that another psychiatry has long been possible.