Tools for a political psychiatry .

Psychiatry

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Frantz Fanon, Alienation and Freedom, eds. Jean Khalfa and Robert J. C. Young, trans. Stephen Corcoran (London: Bloomsbury, 2018). 816pp., £30.00 hb., 978 1 47425 021 4

It is often taken for granted in the psychiatric field that the time for contestation has passed. Terms like ‘anti-psychiatry’ and ‘institutional therapy’, as well as discussions of the image of the patient or ‘madman’ in society now seem outdated. This is partly due to a change of paradigm in the social and political sciences, and is partly the result of broader societal changes. However, to a large degree, it can be explained by a corollary change of paradigm in psychiatry itself: from an approach that tried to criticise our modern society from the viewpoint of the disenfranchised (which had roots in psychoanalytic and phenomenological traditions) to the rise and subsequent near-hegemony of the neurosciences. In the eighties, discourse around psychiatry progressively introduced ideas of the hidden potential relating to so-called ‘mental disorders’ and that of neuroplasticity (e.g. ‘resilience’ under pressure). This transformed what had functioned as a criticism of modern capitalist societies of control into normalised behaviours; mental illnesses became assimilated into circuits of production and consumption. As a result, we are now living in an era in which mental illnesses are increasingly being stripped of their societal significance.

This shift is one of the reasons why the publication of previously unpublished materials by revolutionary psychiatrist and political activist Frantz Fanon is so important today. Although constituted of fragments (including two plays, various scientific articles and a memoir on neuropsychiatry, letters, political articles and – last but certainly not least – Fanon’s library), this volume helps to bring cohesion to an often fragmentarily read oeuvre. In it, we can clearly see an evolution of Fanon’s thought and his increasing political engagement. The volume should serve as a definitive antidote to essays seeking to dim his call for collective liberation and other defenses of social peace under current circumstances.

As a doctor myself officiating in a psychiatric hospital in Belgium, I am confronted on a daily basis with extremely complex situations, whether in consultations, in the ER or with hospitalised patients. Forms of social rejection and economic distress are often intertwined with psychiatric illnesses, which makes this job, as a social worker colleague remarked, a weaving enterprise, slowly putting back threads such as the patient’s current experience of the world, their traumatic past, their social exclusion, their familial relationships (if they are still existent) into a slowly reappearing personality and individuality. All of this is done in increasingly shorter periods of time, due to institutional and societal pressure, and more often than not we are confronted with failures resulting in frustration, of the patient, of course, but also of ourselves as healers. Fanon helped me go into this profession knowing that another psychiatry is possible, one that would question and tackle societal and not only individual issues. He taught me that the clinical was often a reflection of the social. But more importantly, Fanon taught me that another world is possible, one in which the exploitation is finally over. And he taught me to fight for it.

One should start by mentioning the richness of this volume, the number of doors it will open for Fanon enthusiasts everywhere, and it should be said that part of this richness is due to the tremendous work put in by the editors, Robert JC Young and Jean Khalfa. Their introductions to each section provide us with very useful material and in-depth research into the themes explored by Fanon; their notes provide context that allows for sometimes very interesting dialogues between Fanon and a number of his contemporaries (including Henri Ey, Foucault, Le Guillant and Merleau-Ponty). Many of the texts collected intersect with and answer each other from different perspectives: poetic, psychiatric and political.

The psychiatric writings represent the bulk of the book, which opens with Fanon’s dissertation on mental alterations in Friederich’s ataxia, a neurological disease in which patients often show psychiatric symptoms. It is his first major text, written at the same time as Black Skin, White Masks, but published the year before to obtain his medical doctorate. Here, Fanon explores the conditions of possibility for mental illnesses and makes the argument that such illnesses could never emerge solely from ontological (or genetic) alterations. Instead he argues that it is necessary to integrate said differences dynamically with the patient’s social interactions, which will make him or her grow to become a very different human being according to his or her social context:

I do not believe that a neurological disorder, even when inscribed in an individual’s germplasm, can give rise to a determinate psychiatric symptom cluster. Instead, my aim is to show that all neurological impairment damages the personality in some way. And that this open crack within the self becomes all the more sensitive whenever the semiology of the neurological disorder is severe and irreversible.

This dissertation should be seen as integral to his canon and is essential to understand the ground for his later takedown of the primitivist psychiatry of the Algiers School. The latter based its racist theory on the idea that the ‘other’, the Arab, was genetically inferior to white people and had a biological propensity to crime and violence (which were and still often are understood as pathological behaviours). By shifting the scientific gaze from the genetic to the social in his dissertation, Fanon prepared tools that equipped him to understand and dismantle this theory.

Concepts such as sociogeny (the influence of the social and societal context on the making of the personality) or the body schema (a person’s mental bodily image) not only become central in Fanon’s work, they also become essential to understanding his theory of liberation for colonised people, evident in later essays such as ‘Algeria Unveiled’ for instance.

‘Day Hospitalization in Psychiatry’ (1959) is another major text, which could be seen as Fanon’s testament to institutional psychiatry. Based on his experience of managing Africa’s first neuropsychiatric daycare hospital in Tunis, he tackles public mental health issues and defends the day hospitalisation model against what he calls the ‘monsters’, the giant psychiatric hospitals that still exist to this day:

The point is … not to remove patients from the circuitry of social life, but to set in place a therapy that is part of the setting of social life. From the viewpoint of psychiatric assistance, this amounts to an attempt to disengage from the apparently secure atmosphere bestowed by the existence of the asylum.

By dispensing with the carceral logic of the asylum, day hospitalisation changed the relationship of the patient to the institution, and hence changed the relationship between the patient and their own experience:

The patient no longer experiences his possible discharge as the product of the doctor’s benevolence. The a minima master/slave, prisoner/gaoler dialectic created in internment, or in the threat thereof, is radically broken. In the setting of the day hospital, the doctor-patient encounter forever remains an encounter between two freedoms. That condition is necessary for all therapy, but especially in psychiatry.

In this innovation, Fanon was, ahead of his time, a precursor to Franco Basaglia’s Law 180 in Italy. (Basaglia, who is known to have been influenced by Fanon’s work, wrote a significant commentary on his letter of resignation to the French Algerian Governor in 1956.) It is important to not only read Fanon’s article in relation to our present decaying institutions, but also to connect them to the revolutionary decolonial climate in which he operated, and which provided the conditions of possibility for his project to succeed.

The psychiatric section of the collection also highlights his pedagogical engagements, both through the collection of many of his ‘psychoeducative’ editorials from the internal journal of the Blida Psychiatric hospital that he founded in 1953, and through the class he taught at the University of Tunis in 1959-1960 on Psychiatry and Society. (Unfortunately, a third body of pedagogical work has been lost: a class on Sartre’s Critique of Dialectical Reason that he taught to cadres of the FLN (the Algerian National Liberation Front).) In the former, he tried to teach both the nursing staff at Blida hospital and his patients socialtherapy, through tackling daily issues that would occur in the hospital; issues that arose mainly from resistance to the introduction of his new methods. The latter was an ex cathedra course aimed to introduce psychiatry to an audience of young intellectuals, both in its mainstream repressive use as well as in his own reformulation of it in a revolutionary setting. Both texts are easy to read (one of them is penned by a student of Fanon’s) and contrast with the rest of the volume in their simplicity, proving Fanon’s point that ‘To write is to want to be read. It is then also to want to be understood’, as he says in one of the editorials.

Another group of his psychiatric texts aim to introduce his concept of sociogeny in the psychiatric field. By analysing the local customs and social characteristics of North Africans, and integrating them into his psychiatric practice, Fanon undermined the School of Algiers’ claim that the North African is congenitally mentally deficient and highlighted the limitations of his own school of thought: ‘social therapy’. His biographers describe the period in which he wrote these articles as extremely productive: Fanon was spending day after day treating patients at the hospital and night after night out and about in the region with his intern and acolyte Jack (later Jacques) Azoulay (who co-authored his article regarding the limitations of socialtherapy). In this period, Fanon was getting acquainted with local customs and with a culture of which he was ignorant before he arrived to Blida in 1952. This allowed him to identify the elements that were central to the Arabic/Berber culture and that could in turn be incorporated into a hospital unit in order to make it a meaningful place (‘un lieu de sens’) for the patients. The cultural relativism and overall perspicacity that such a methodology entailed were completely new in the socialtherapeutic field and, obviously, at odds with primitivism.

Finally, the volume comprises texts concerned solely with clinical trials, some of which are co-authored. These texts reveal how deeply implicated Fanon was in medical research, despite the scarcity of resources he had at hand. They explicitly show that Fanon didn’t see psychiatry as an isolated discipline, but instead wanted it to have close relationships with other medical specialities. Although profoundly philosophical and political, his work was nonetheless medical, in that it centred on the lessening of patients’ suffering.

The earliest texts of this collection are in the first section of the volume: two plays written in 1949, when Fanon was 24 years old. Both plays are valuably indicative of what would become two central themes of Fanon’s oeuvre: while the question of the body is omnipresent in The Drowning Eye, the problem of the legitimacy of violence in bringing about a ‘new man’ is at the heart of Parallel Hands. A third play, ‘La Conspiration’, if Fanon ever completed it, is unfortunately lost.

The most striking aspect of The Drowning Eye is its language: an exuberant, symbolistic poetic style, reminiscent of Glissant and Césaire, where bodily sensations and perceptions are pushed to the extreme. The explosive vitality of the language used is heightened by the contrast it offers to the sobriety of the plot: two brothers (not so much unlike Fanon’s brother Joby and himself) are rivals in seducing a young woman. Although deeply influenced by the negritude movement, Fanon was already distancing himself from it, avoiding essentialising the Black experience in any way. Instead his use of the semantic field of the ‘body’ prefigures his own developments on the body schema and the breaking into pieces of the colonised body. While The Drowning Eye may be read as Fanon’s inventory of the pieces, several essays of A Dying Colonialism may be considered as attempts to bring these fragments back into a cohesive whole.

Parallel Hands powerfully preempts The Wretched of The Earth, both in the sense that it asks the question of the appropriation of power (with its related question of the legitimacy of violence) and in the way it tackles the need for a new humanity to rise, a concern that is present in the emphatic call of the later book’s last pages.The influence of Nietzsche is pervasive, through the dramatisation of that new rising, a theme explored in Fanon’s oeuvre by Jamaican philosopher and critic Sylvia Wynter.

The political writings in the collection are mostly articles from El Moujahid, the FLN’s newspaper, to which Fanon contributed from 1957 until 1960. Those familiar with his posthumously published articles collected in Towards An African Revolution will recognise his astute political and psychological analysis of the colonial machine and its propaganda, with much still relevant to this day in colonial contexts such as Palestine (e.g. the first article ‘The Demoralised Foreign Legion’, which describes the psychological conditioning of the colonial army). An article that stands out is his denunciation of Patrice Lumumba’s assassination in ‘Africa Accuses the West’. The emotion in this text makes it clear that Fanon considered Lumumba as nothing short of a brother: ‘Patrice Lumumba died knowing that his sacrifice would contribute to his people’s victory. May he live forever in the hearts of fighters for a free Africa.’

The section ends with a short letter to Iranian revolutionary Ali Shariati, which discusses religion and the place it could hold in the decolonisation process, a theme rarely tackled in Fanon’s oeuvre. As he wrote to Shariati: ‘I would like to emphasise, more than you do yourself, your remark that Islam harbours, more than any other social powers of ideological alternatives in the third world (or, with your permission, the Near and Middle-East), both an anticolonialist capacity and an anti-western character.’ This is unfortunately only one of four letters he exchanged with Shariati, the rest of them are lost to us. It underlines the need for further research on, and publication of, Fanon’s correspondence.

The fourth section can be read like an epistolary novel. It contains letters exchanged between Fanon and his publishers François Maspero and Giulio Einaudi (assisted by Giovanni Pirelli). Those letters show the difficulties encountered and the risks faced by his publishers during that period, as well as the will of Fanon to have his last book, The Wretched of The Earth, published and disseminated as widely as possible, especially in African countries.

The last section, as alluded to earlier, is a real gift. Not only is it an inventory of the books said to have belonged to the author, but the editors have also transcribed significant annotations made in the books by Fanon. Although these additions provide no big surprises, one can relish reading Fanon’s violent comments added in the margins of racist allegations by famous psychoanalysts. For example, Fanon wrote ‘Bastard’ in the margin of Freud’s Introduction to Psychoanalysis, alongside the sentence ‘the primitive man made work acceptable at the same time as he used it as an equivalent and substitute for sex-activity’, and ‘Shit, and when I think that there exists a psychoanalysis based on this psychology’ in the margins of a book by Jung. Most revealing are the notes on his philosophical and political influences (Sartre being the most annotated author). This makes this section a very compelling read.

The concept of alienation is central to this volume and Fanon didn’t separate the psychiatric from the political. The alienation he was fighting within the psychiatric setting, through aiming to restore the patient’s agency and control of his or her own life – their disalienation – by using tools from social therapy as well as from his own research, was the same alienation he fought in the political field, by dissecting the colonial machine and joining his forces to the revolutionary effort of the Algerian People (and thereby the whole African continent and beyond). He saw both alienations as one, stemming from a capitalist and racist society that found the peak of its development and its barbary in colonialism, and in the enslavement of human beings to what he called elsewhere ‘the abjection of those who want to make of the Man a machine’. He articulated the entanglement of the social and the psychic and hence of the political and the psychiatric in a letter to the Resident Minister in Algiers in 1956:

If psychiatry is the medical technique that sets out to enable individuals no longer to be foreign to their environment, I owe it to myself to state that the Arab, permanently alienated in his own country, lives in a state of absolute depersonalisation …. The extant social structure in Algeria stood opposed to any attempt to put the individual back in his or her place.

Fanon’s work is essential in that it represents the most fruitful meeting of psychiatry and politics to this day and provides us ‘technicians of practical knowledge’, or intellectuals, with a deeper purpose than to protect and replicate our current institutions.