In January 1940, a mustachioed Catalonian anarcho-communist arrived at the door of the Saint-Alban psychiatric asylum in the mountains of southwestern France. The doctor wore round spectacles; his wild, curly hair grew out sideways from a prematurely balding scalp. Francesc Tosquelles came with little more than a book in each of his pockets. In one was the work of an obscure German psychiatrist about therapeutic practice; in the other, the thesis of French psychoanalyst Jacques Lacan.<\/p>\n
Just 28 years old, the diminutive, loquacious Tosquelles \u2014 who had fled Spain with a bounty on his head as a member of the resistance movement against the dictator Francisco Franco and crossed the Pyrenees mountains into France on foot \u2014 was the special invitee of Paul Balvet, Saint-Alban\u2019s director. Balvet had heard the tales of a peculiar individual treating traumatized Spanish Republicans at a refugee camp near Perpignan.\u00a0<\/p>\n
Balvet wanted to speak to Tosquelles about his radical approach to psychiatry, which seemed to be working on the Spanish exiles. In a time when chains and electric shocks were de rigueur, Tosquelles\u2019 goal was simple: Instead of treating sick individuals, he sought to treat a sick society. And that started with breaking down the barriers between the mentally ill and the rest of the community through shared cultural experiences and collectivist work.<\/p>\n
Over the coming decades, Tosquelles instituted a radical shift in the Saint-Alban psychiatric ward\u2019s approach to treating the mentally ill, borrowed from avant-garde Catalonian thinkers of the 1930s and repackaged for French people suffering from the dual traumas of war and occupation. He sought to transform the asylum from a repressive prison-like apparatus into something more akin to an open commune. He started involving his patients in a variety of activities aimed at occupying their hands and their minds: gardening, singing, theater productions. Patients suffering from mental illness and shell shock started their own newspaper, which was sold to help defray the costs of the clinic.<\/p>\n
What Tosquelles probably didn\u2019t imagine as he made his way to Balvet\u2019s office on that January day in 1940 is that \u2014 over a decade later \u2014 this approach to psychiatry would have an equally seismic impact in a very different context: French colonial Algeria. In the years after World War II, as Saint-Alban became a model for the emerging field of \u201cinstitutional psychiatry,\u201d as Tosquelles\u2019 movement came to be known, it attracted a number of Marxist, radical and left-leaning practitioners eager to work with the Spaniard, who had become something of a medical superstar.<\/p>\n
And, in the spring of 1952, one of them was a young Martinican psychiatrist by the name of Frantz Fanon \u2014 today celebrated as one of the world\u2019s greatest theorists of the postcolonial struggle.<\/p>\n
Even today, getting to Saint-Alban is not easy. The hospital is located at an altitude of over 3,000 feet along small roads that wind up into the French Pyrenees from the southwestern city of Toulouse. Nowadays, the A62 highway runs nearby, but in Tosquelles\u2019 time, the clinic \u2014 a medieval castle converted into a sprawling hospital serving 700 patients \u2014 was such a backwater that an assignment there was considered to be an unlucky draw for young medical interns, explained Coline Fournout, a graduate student in medical anthropology at McGill University in Quebec, who is writing her thesis on Saint-Alban.<\/p>\n
The conditions, bad for medical interns, were much worse for the hospital\u2019s patients. In 1940, Tosquelles arrived in the midst of a difficult period for France\u2019s psych wards. Since the war had begun the previous fall, French hospitals found themselves underfunded and overcrowded, with psychiatric patients particularly vulnerable to abuse. In all, an estimated 45,000 psychiatric patients died \u2014 mostly from starvation, hypothermia and other preventable causes of death \u2014 during the conflict. According to one French historian, the biggest killer of French psych patients was simple neglect.<\/p>\n
Saint-Alban was no exception. Though the asylum had begun to modernize in the 1930s, under director Agn\u00e8s Masson, conditions had degraded during the war.\u00a0<\/p>\n
\u201cIt was really like a prison,\u201d Fournout said. \u201cThere was no running water, large dormitories with hundreds of people living on top of one another, broken down by pathology: all the alcoholics together, all of the epileptics together, all the schizophrenics together.\u201d<\/p>\n
These poor conditions, Tosquelles theorized upon his arrival, were exacerbating the mental illnesses his patients suffered from. \u201cThe fundamental idea was that all human interaction is potentially therapeutic and that conditions should therefore be created to enable interaction between people,\u201d Fournout told New Lines. \u201cFor Tosquelles, psychiatric treatment was social in nature.\u201d\u00a0<\/p>\n
Instead of relegating madness to the dark corners of society, Tosquelles sought to accept it as part of a broader humanity. \u201cWithout the recognition of the human value of madness, it is man himself who disappears,\u201d Tosquelles would later write in his memoir.<\/p>\n
Tosquelles began to look to the local community for solutions. Gazing out into the abundant pastures surrounding the castle grounds, Tosquelles spotted an opportunity to address two problems at once: hunger and mental illness. Quickly, he put his psych patients to work in the fields, harvesting and gardening alongside the local farmers. The idea, Fournout said, wasn\u2019t to exploit them, but to \u201cactivate\u201d them, physically and mentally, and include them in the broader community rather than imprisoning them in dark cells far from any contact with the outside world.<\/p>\n
The sessions working outside were accompanied by other activities. Tosquelles opened a cafe in the hospital grounds for Saint-Alban patients, medical staff and town residents alike. Patients produced a weekly newspaper called The Hyphen that ran until the 1970s. They put on plays and screened films for the community. They started a patient-run social club and physically broke down the centuries-old wall that surrounded the asylum.<\/p>\n
In a matter of months, Saint-Alban was fully transformed: for its patients, into a bustling hive of cosmopolitan activity, for Tosquelles\u2019 friends \u2014 exiles, outcasts and Resistance fighters engaged in the struggle against both the Franco and Vichy regimes \u2014 into a revolutionary hideout.<\/p>\n
When, in November 1942, the Nazis crossed the demarcation line and invaded Southern France, the new occupiers were so sure that the hospital was a nest of Resistance activity that they would leave the bodies of captured and killed Resistance fighters on the hospital\u2019s doorstep during the night.<\/p>\n
Over the years, the hospital\u2019s surreptitious guests included the French Resistance poet Paul \u00c9luard; Tristan Tzara, one of the founders of the Dada movement; and the French surrealist and communist Lucien Bonnaf\u00e9, who later would become the hospital\u2019s director.<\/p>\n
The clinic\u2019s revolutionary reputation might be what caught the young Fanon\u2019s eye in the spring of 1953 \u2014 eight years after the liberation of France.<\/p>\n
Like Tosquelles, Fanon, who was born 100 years ago this July, would have been around 27 years old when he first heard of Saint-Alban. Though Fanon had grown up in Martinique, in January 1943, like many of France\u2019s colonial subjects living in the sprawling network of overseas territories and protectorates, he joined the country\u2019s exiled Resistance army in the fight against Nazi Germany \u2014 helping to liberate southern France in August of the following year.\u00a0<\/p>\n
After the war ended, Fanon settled in Lyon, where he began working at a hospital and writing the medical dissertation that would come to be known as \u201cBlack Skin, White Masks.\u201d It was around this time that Fanon caught wind of Tosquelles. By then, despite its humble roots, Saint-Alban had an excellent reputation, Fournout explained \u2014 so much so that members of the Parisian bourgeoisie had begun to send their sons and daughters there for treatment, and ambitious medical interns from across France sought entry into the institution.<\/p>\n
When the young Fanon arrived at the hospital, Tosquelles later remembered, he told the Spanish doctor that he had heard of a psychiatric practice \u201cthat was attentive above all to the complexity of the differences \u2014 maintained and sometimes tragically reinforced \u2014 that bound us together as men.\u201d\u00a0<\/p>\n
In this golden era of institutional psychiatry, and despite their differences in age and fame, Fanon and Tosquelles immediately connected. \u201cFanon\u2019s admiration, but also his personal affection for Tosquelles were perceptible in the way he spoke to us later, at Blida,\u201d Alice Cherki, a psychiatrist who worked with Fanon in Algeria, wrote in her 1975 biography of the psychiatrist.<\/p>\n
The young doctor spent 15 months in Saint-Alban studying under Tosquelles\u2019 wing \u2014 helping support the development of the social club, organizing conferences and contributing to the newspaper.\u00a0<\/p>\n
The roots of Fanon\u2019s theory of \u201cdisalienation\u201d \u2014 the idea that for the colonized to escape from their physical chains they also needed to break down the mental barriers holding them back from doing so \u2014 which he would later deepen through his political activism and writings, began to develop during this time, according to Cherki.\u00a0<\/p>\n
At Saint-Alban, Fanon found \u201ca meeting point where alienation is questioned in all its forms: the somatic and the psychic, the structural and the historic,\u201d she writes. Unlike at other hospitals where he had worked \u2014 in Lyon, back home in the Antilles \u2014 at Saint-Alban, Fanon began to see the convergence of two worlds: the psychiatric and the political.\u00a0<\/p>\n
But it was in Algeria, at the Blida-Joinville Psychiatric Hospital, where the young doctor would have the opportunity to finally test out these ideas for himself.\u00a0<\/p>\n
Sitting in her art-filled psychiatric practice with a view of Paris\u2019 famous zinc roofs, Cherki, Fanon\u2019s biographer, who is now 89, smiled as she recalled Fanon\u2019s turbulent beginning at Blida.<\/p>\n
Cherki was just 23 when she met Fanon at a conference in Algiers. A member of the Jewish-Algerian community, Cherki had fallen in with the pulsing network of intellectuals, artists and politicians pushing for the creation of an independent, religiously diverse and progressive Algeria. When Fanon asked her to join him at Blida, a sprawling hospital complex about 25 miles south of the capital, the psychiatry student immediately said yes. She had heard of the burgeoning institutional psychiatry movement in France, but the ideas had not yet taken hold in the traditionalist Algiers school of psychiatry.<\/p>\n
As had been the case at Saint-Alban during World War II, the conditions of detention for Blida\u2019s patients in the early 1950s were abysmal. Fanon was shocked to find schizophrenia and tuberculosis patients isolated, nearly nude, and forced to sleep on beds of hay. Other patients were chained to their beds or tied to trees outside.\u00a0<\/p>\n
Fanon\u2019s demands that these patients be freed from their chains were not taken well by the staff, including the director of the hospital. Nor did his initial solutions, imported from Saint-Alban, succeed in motivating patients in this entirely different context, Cherki explained.\u00a0<\/p>\n
\u201cHe stumbled at first,\u201d Cherki said of Fanon\u2019s first steps on North African soil. \u201cWhen he arrived and started to do everything that Tosquelles had done at Saint-Alban \u2014 the theater, the newspaper, the bar, all of these very European things \u2014 he realized that this didn\u2019t work at all.\u201d<\/p>\n
It took time to adjust to local needs, but Fanon insisted on finding ways to open the asylum to the community. He began to cater his psychiatric practice to the needs of his Muslim patients and staff. The bar was replaced by an Algerian-style cafe; he had local musicians, including the chaabi artist Abderrahmane Azziz, play concerts. As at Saint-Alban, patients produced and distributed a newspaper, which they dubbed Notre Journal (Our Newspaper). In an abandoned field next to the clinic, Fanon inaugurated a soccer pitch where patients and medical staff would play together. He converted a grain silo into a mosque for the patients.\u00a0<\/p>\n
As it had for Tosquelles in his fight against rising fascism in Spain and France, Fanon\u2019s psychiatric work increasingly began to converge with his own burgeoning political engagement. Fanon\u2019s travels into the mountains of Kabylia to research traditional Algerian medicinal and spiritual practices introduced him to members of Algeria\u2019s national liberation movement, Cherki writes.\u00a0<\/p>\n
Like Tosquelles before him, Fanon began to shelter members of the National Liberation Front (FLN), an insurgent guerrilla movement that had risen up against the colonial French government, within the walls of the hospital. These included Abane Ramdane, an Algerian freedom fighter who had earned the nickname \u201carchitect of the revolution.\u201d<\/p>\n
His increasingly militant role led Fanon to new observations about the links between mental illness and the colonial condition \u2014 and, eventually, away from Blida.\u00a0<\/p>\n
The famous French neuroscientist Jean Oury once remarked that Tosquelles walked on two legs: Marxism and psychoanalysis. The same could be said for Fanon, whose time at Blida coincided with the development of some of the political arguments that would later appear in \u201cThe Wretched of the Earth,\u201d his seminal work, and his growing ties to the FLN \u2014 for which he would eventually go on to become the spokesperson.\u00a0<\/p>\n
\u201cImperialism, which today is waging war against a genuine struggle for human liberation, sows seeds of decay here and there that must be mercilessly rooted out from our land and from our minds,\u201d Fanon wrote in the introduction to the final chapter of the \u201cWretched of the Earth,\u201d entitled \u201cColonial War and Mental Disorders.\u201d \u201cThe truth is that colonization, in its very essence, already appeared to be a great purveyor of psychiatric hospitals.\u201d\u00a0<\/p>\n
Between January 1954, when he landed in Algeria, and 1957, when he was forced into exile, Blida became Fanon\u2019s revolutionary clinic. Fanon observed with horror the experiences of Algerian liberation fighters he had met and treated, as well as civilians affected by the bloody conflict that killed an estimated 500,000 to 1.5 million Algerians. In \u201cColonial War and Mental Disorders,\u201d Fanon dissects the case of a man whose wife was raped by French soldiers and who had come to him suffering from migraines and insomnia. He writes about the survivor of a massacre who went on to have homicidal impulses.\u00a0<\/p>\n
The trauma of these men and women suffering from so-called mental illnesses, he realized, came not from their own minds, but from the violence of the colonial situation they were experiencing. It was the depth and breadth of these reflections that would eventually elevate Fanon from a psychiatrist to a freedom fighter, explained Paul Marquis, a historian of postcolonial psychiatry at the French National Center for Scientific Research.\u00a0<\/p>\n
\u201cFanon saw the reform [of mental health work] on the scale of the hospital as a whole, and even society as a whole,\u201d Marquis told New Lines, \u201cand so he gave the reform a scope that was really different from what had been done up until then.\u201d\u00a0<\/p>\n
Fanon\u2019s utopian dream, inherited from Tosquelles, was ultimately one of universality, according to Cherki. \u201cHe even said that once colonialism was \u2018over,\u2019 the colonized and the colonizers would be able to work together,\u201d she said. \u201cThat was really the case then, and I knew him very well. I can tell you, he never deviated from this belief throughout his life.\u201d\u00a0<\/p>\n
But political reality was another thing. As his engagement with the FLN deepened and the French repression of the guerrilla movement became more violent, Fanon was increasingly drawn toward activism. In 1956, after nearly three years, Fanon quit his post at Blida and renounced his French citizenship. For several months, Cherki writes, Fanon\u2019s own staff members had been suffering as a result of the French counterinsurgency. Some were rounded up and arrested, some were killed and others simply disappeared.\u00a0<\/p>\n
The end of his utopian experiment felt inevitable. In January 1957, Fanon left Algiers for Tunis, where he met up with other members of the FLN\u2019s resistance-in-exile. Fanon became the spokesperson for El Moudjahid, the independence movement\u2019s newspaper, and traveled across Africa, meeting with leaders of other newly independent nations to drum up support for the Algerian independence movement.\u00a0<\/p>\n
The years in Blida left an indelible mark on Fanon. In \u201cThe Wretched of the Earth,\u201d He dedicates a significant section of the analysis to the Algerian case, ultimately concluding that the independence battle he had joined was not just a fight for territory, but for humanity.\u00a0<\/p>\n
\u201cThe criminality of the Algerian, his impulsiveness, the savagery of his murders are not, therefore, the consequence of how his nervous system is organized or specific character traits, but the direct result of the colonial situation,\u201d Fanon wrote. \u201cAs soon as you and your fellow men are cut down like dogs there is no other solution but to use every means available to reestablish your weight as a human being.\u201d<\/p>\n
Fanon would not live to see the success of the Algerian Revolution \u2014 nor the decline of the institutional psychiatry movement he had helped to internationalize.\u00a0<\/p>\n
After his stint in Tunis, where he continued to operate as a psychiatrist at a day clinic, Fanon fell ill with tuberculosis. His health declined rapidly and, despite attempts to treat him, first in Moscow and then in Bethesda, Maryland, he died in December 1961 at the age of 36.<\/p>\n
The next year, with the \u00c9vian Accords, France begrudgingly granted Algeria its independence, ending the FLN\u2019s nearly decade-long struggle. Around this time, something else happened. Even as Fanon\u2019s political legacy grew, his psychiatric influence began to wane, as medical advances and political changes dulled the sharpness of the institutional psychiatry movement. Nowhere was this more pronounced than in Algeria itself.<\/p>\n
That\u2019s what Idriss Terranti, a pediatric psychiatrist in Constantine, began to notice as a student in newly independent Algeria. Coming of age in the 1970s and \u201980s, Terranti knew of Fanon only from rare commemorative plaques or oblique references in political meetings, as he recalls in an article in the journal Politique Africaine, titled \u201cDeflected Hope, Destiny Yet To Be Realized. What Is Left of Fanon in Algeria?\u201d \u201cThe least that can be said about this period is that Frantz Fanon\u2019s influence did not inspire Algerian psychiatric practice after independence,\u201d Terranti writes. The first international conference on Fanon\u2019s work to take place in Algeria didn\u2019t occur until 1987, and even then the topic was Fanon\u2019s political writings, not his psychiatric legacy.\u00a0<\/p>\n
In the 1960s and \u201970s, with the advent of modern psychiatric medicine, the twin paths of Fanon in Algeria and Tosquelles in France seemed to dovetail once again. In 1962, as Algerians were gaining independence, Tosquelles left Saint-Alban. Other experiments in institutional psychiatry \u2014 first in Marseille and then in the Parisian suburb of Melun \u2014 didn\u2019t catch on. \u201cIn 1950, they discovered anxiolytics\u201d \u2014 medications that treat anxiety, like Valium \u2014 Tosquelles is quoted as saying years later. \u201cAnd from that moment on, psychiatrists said, \u2018Great, we don\u2019t have to worry about patient-doctor relationships anymore.\u2019\u201d<\/p>\n
Still, according to Melanie Henry, a historian in Cairo who studies postcolonial psychiatry in the Middle East and North Africa, Fanon \u2014 and through him Tosquelles \u2014 has lived on in other psychiatric contexts. \u201cStarting from the 1970s, initiatives aimed at destigmatizing psychiatry, madness, and psychological suffering began to emerge on an individual level across the region,\u201d Henry said. These initiatives grew and were sometimes formalized by public health institutions starting from the 1990s and 2000s.\u00a0<\/p>\n
In recent years, psychiatrists and psychologists including Abdelhak Benouniche and Karima Lazali have increasingly returned to Fanon\u2019s psychiatric work, she said. Fanon\u2019s work, and that of other institutional psychiatrists, has inspired similar experiments at hospitals in Algeria, Morocco and Tunisia, she added.\u00a0<\/p>\n
In France, the hospital at Saint-Alban is now called Fran\u00e7ois Tosquelles \u2014 after the French version of the psychiatrist\u2019s name. Each year, in late June, the hospital hosts a conference that brings together researchers and practitioners working to improve care for a new generation of patients.\u00a0<\/p>\n
At the Sidi Chami psychiatric hospital in Algeria\u2019s coastal city of Oran, Sarra Benharrats said, \u201cMy psychiatry idol is Fanon. With my students, I tend to use Fanon as an example to explain the value of a psychiatry that focuses on having a close personal relationship with patients in order to help them, and that breaks from chemical dependence.\u201d<\/p>\n
Benharrats added that Fanon\u2019s struggle against colonialism, both on an individual and psychiatric level, through his invention of the concept of \u201ccolonial psychiatry,\u201d is an example that should be followed even today.<\/p>\n
Despite limited means, Benharrats has made great efforts to include Fanonesque practices in her work, including ergotherapy (activation through work) and music therapy. These techniques, she said, have led to prolonged remission phases and the prevention of relapses for her psychiatric patients: proof, to her, that the institutional psychiatry that Fanon preached might not be lost on today\u2019s patients.<\/p>\n
\u201cThere are times when we forget Fanon \u2014 his actions, his improvements, and his impact on psychiatry,\u201d Benharrats said. \u201cAnd then, at other times, we come back to him. I just keep telling my fellow teachers that we must not stop talking about him, because future generations tend to forget.\u201d<\/p>\n