Frantz Fanon's Psychotherapeutic Approaches to Clinical Work

Practicing Internationally with Marginalized Communities

Lou Turner, Helen Neville, Lou Turner, Helen Neville

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429878220
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Recognizing Frantz Fanon's remarkable legacy to applied mental health and therapeutic practices which decolonize, humanize, and empower marginalized populations, this text serves as a timely call for research, education, and clinical work to establish and further develop Fanonian approaches and practices.

As the first collection to focus on contemporary clinical applications of Fanon's research and practice, this volume adopts a transnational lens through which to capture the global reach of Fanon's work. Contributors from Africa, Australia, Europe, and North America offer nuanced insight into historical and theoretical methods, clinical case studies, and community-based innovations to place Fanon's research and practice in context. Organized into four key areas, including the Historical Significance of Fanon's Clinical Work; Theory and Fanonian Praxis; Psychotherapeutic and Community Applications; and Action Research, each section of the book reflects an impressive diversity of practices around the world, and considers the role of political and socioeconomic context, structures of gender oppression, racial identities, and their intersection within those practices.

A unique manifesto to the ground-breaking and immensely relevant work of Frantz Fanon, this book will be of great interest to graduate and post graduate students, researchers, academics and professionals in counselling psychology, mental health research, and psychotherapy.

Section 1
Fanon’s Clinical Work in Historical Context

1
Frantz Fanon, Institutional Psychotherapy, and the Decolonization of Psychiatry

Camille Robcis

In December 1956, Frantz Fanon resigned from his position as medical director of the psychiatric hospital of Blida-Joinville in Algeria. In a letter addressed to the Resident Minister and Governor General Robert Lacoste, Fanon (1967) explained that after three years of arduous work to improve the mental health of the local population, the reality of colonialism, its “tissue of lies, cowardice, [and] contempt for man” had finally convinced him to leave:

Madness is one of the means man has of losing his freedom. And I can say, on the basis of what I have been able to observe from this point of vantage, that the degree of alienation of the inhabitants of this country appears to me frightening. If psychiatry is the medical technique that aims to enable man no longer to be a stranger to his environment, I owe it to myself to affirm that the Arab, permanently alien [aliéné permanent] in his own country, lives in a state of absolute depersonalization.

(p. 53)

By choosing the adjective aliéné to describe the colonized Algerians, Fanon was playing with the double meaning of the term in French: estranged and foreign—even in their own land—but also mentally unstable, crazy, insane. More broadly, Fanon was articulating a point that he reiterated throughout his life: colonialism had a direct psychic effect. It could literally render someone mad by hijacking their person, their being, and their sense of self. The confiscation of freedom and the alienation brought about by colonialism and by racism were always political and psychic at once.

By the time Fanon wrote this letter in 1956, the war in Algeria had turned increasingly violent. Guy Mollet, the new prime minister elected earlier that year, was greeted by tomatoes and furious crowds in Algiers in February 1956. The following month, the French legislature voted to grant the government “special powers,” giving the army free reign to reestablish order in Algeria. Fanon had followed the intensification of the war closely and by 1956, he was already involved with the Front de Libération Nationale (FLN) which had reached out to him in his capacity as a doctor to provide drugs and medical advice—including psychiatric help—for the combatants. As Fanon (1967) explained in his letter to Lacoste, he had finally come to realize that his “absurd gamble” to promote progressive psychiatric reforms while serving the French State was hopeless. As he put it, it had become increasingly obvious that “the social structure existing in Algeria was hostile to any attempt to put the individual back to where he belonged…. The events in Algeria are the logical consequence of an abortive attempt to decerebralize a people” (p. 53). Violence, in other words,—political, social, and psychic—was constitutive of colonialism: it was the structure of the land, a structure that had come to condition individuals in their very psyche.

Fanon’s letter gives us a particularly good entry-point into his conception of the psychiatric which is the subject of this essay. More precisely, I wish to highlight two of the hypotheses that Fanon formulates in his letter: first, that the political and the psychic are intimately tied; and second, that the social space and the physical environment of the colony, the enclosure and the segregation on which they are premised, fundamentally shape the psyche of the colonized. Fanon had intuited these theses from his most early work, especially in Black Skin, White Masks and “The North African Syndrome,” both published in 1952. However, as I wish to argue here, it was his residency at the hospital of Saint-Alban from 1952 to 1953, his encounter with François Tosquelles, and his discovery of institutional psychotherapy that ultimately confirmed for him, on an empirical level, that alienation was always social and psychic at once.

Institutional psychotherapy played a key role in Fanon’s thought and medical practice not only by giving him the tools to diagnose what Tosquelles called the concentrationist logic of asylums (but also, as Fanon would suggest, of the colonial world). It also offered Fanon an example of what dis-alienation, freedom, and emancipation could look like within the hospital and also within society at large. After leaving Saint-Alban, Fanon tried to enact these experiments inspired by institutional psychotherapy, both in his clinical work in Algeria and Tunisia and in his political writings. As I want to show, Fanon neither applied nor adapted a model of Western psychiatry to the colonial settings of Algeria and Tunisia. Rather, he revised the very foundations of this framework in order to promote what he considered a truly disalienated and disalienating psychiatry, a psychiatry close to the notion of “national culture” that Fanon theorized in his last and best-known book, The Wretched of the Earth.

To be sure, the fact that Fanon practiced psychiatry throughout his life is not new (Bulhan, 1985; Cherki, 2000; Keller, 2007a; Khalfa, 2015; Macey, 2012; Mbembe, 2016; Ranzanajao & Postel, 2007; Vergès, 1997). My aim in this chapter is thus not to underscore once again the importance of psychiatry in Fanon’s work. Rather, I want to argue that the evolution of Fanon’s thought across institutional and political/decolonial contexts explains as much about the history, promise, and achievements of institutional psychotherapy as it does about his political thinking. My point is to highlight the significance of Fanon in the genealogy of what is generally called “Western radical psychiatry.”¹

Fanon’s Theory of the Subject

Fanon left his native island of Martinique to study medicine in Lyon in 1946. He chose to specialize in psychiatry in 1949 under the supervision of Jean Dechaume, an expert in psychosurgery, neuropsychiatry, and neurology. At the time, French university training in the domain of psychiatry was dominated by an organicist and neuropsychiatric approach to mental illness, and this was especially true of Lyon. Fanon admired Dechaume’s scientific rigor and he retained a certain inclination for this type of empiricism throughout his life. However, he quickly felt constrained by the theoretical narrowness of psychiatry and turned to other fields, including literature, anthropology, philosophy, and psychoanalysis. While at Lyon, he attended the lectures of the anthropologist André Leroi-Gourhan and of the philosopher Maurice Merleau-Ponty. He read extensively and engaged the main intellectuals of his period: Claude Lévi-Strauss, Marcel Mauss, Karl Marx, Vladimir Lenin, G.W.F. Hegel (mediated by Alexandre Kojève and Jean Hyppolite), Martin Heidegger, and Jean-Paul Sartre. During these years, Fanon also immersed himself in psychoanalysis through Freud and Lacan, and in Gestalt theory through Kurt Goldstein. Finally, he wrestled with the theses of Henri Ey and other French psychiatrists gathered around the journal Évolution Psychiatrique who had been trying to reconcile psychiatry and psychoanalysis since 1925. From existentialism and anthropology, Fanon learned the importance of relationality in the construction of the self. Through Marxism, he came to appreciate the decisive effect of politics on the human condition. Psychoanalysis and phenomenology offered him a theory of embodiment that complemented social construction. Bringing together these different currents and disciplines, Fanon spent much of his time in medical school thinking about psychic causation, trying to untangle the biological from the psychological, and separating the role of phylogeny, ontogeny, and sociogeny in the constitution of the self.

Fanon’s medical thesis centered on Friedreich’s ataxia, a hereditary disease that causes progressive damage to the nervous system. As he explained in his introduction (2018), this illness was of particular interest to him because despite the fact that the state of general paralysis was “eminently neurological,” it was usually accompanied by “a certain psychiatric symptom cluster” (p. 206). The close study of Friedreich’s ataxia was thus for Fanon a way to ponder a fundamental medical—but also philosophical—quandary: “At what point can a neurological disease be suspected of triggering psychic alterations? At what point can it be said that the thought processes are disturbed?” (p. 224). This was another way to delimit neurology and psychiatry, to reflect on the problem of specialization and disciplinary borders (p. 247). In order to think through these questions, Fanon turned to the works of Henri Ey, Jacques Lacan, and Kurt Goldstein—three of his contemporaries who were also crucial for the doctors at Saint-Alban. In his thesis, Fanon mapped out the substantial differences between their respective approaches before suggesting that the three figures were linked by their desire to undercut the dichotomy between the neurological and the physiological. Ey, Fanon wrote, remained committed to a neurological framework despite the fact that he underscored the psychic nature of pathogenesis (p. 255). For Goldstein, “every organic manifestation … is the fruit of global mechanisms. For him, the organism acts as a whole” (p. 255). In both cases, Fanon observed, neurological and psychiatric troubles went hand-in-hand.

Significantly, Fanon ended his thesis with an extended discussion of Lacan whose work appeared closest to his own position. Referring to Lacan as an “eminently controversial figure,” Fanon highlighted two concepts in Lacan’s early work that he found especially helpful (p. 262). The first was his concept of desire, which provided a link between on the one hand the biographical development of the subject and, on the other, his lived experience (his Erlebnis—a term that Fanon would take up in Black Skin, White Masks), his ego ideal and his relationships (and tensions) with others (p. 264). The second was Lacan’s notion of personality, especially important in his 1932 thesis on paranoia, which Lacan defined phenomenologically as both grounded in genetics and able to integrate human relations of the social order (p. 265).² According to Fanon, through his concepts of desire and of personality, Lacan stressed the fact that madness always had something to do with the social.

Fanon’s wish to complicate the classic (but by then much-contested) medical dictate that every symptom requires a lesion was not, however, simply motivated by his wide range of readings. It was also inspired by his first experiences in the medical field even before he chose to specialize in psychiatry. Indeed, throughout medical school, Fanon was regularly asked to accompany doctors who had to attend emergencies in a predominantly Muslim neighborhood of Lyon. Fanon describes finding patients in dirty beds, in sordid rooms, with friends and family weeping and screaming because they were convinced that the patient was on the brink of death. Fanon and the supervising doctors would proceed to an examination that would generally reveal no significant illness. Eventually, and in response to further complaints by the patient, the doctor would recommend further testing. Three days later, the same person would show up completely cured and the French doctors would conclude that “the North African’s pain, for which we can find no lesional basis, is judged to have no consistency, no reality” (Fanon, 1967, p. 6). This verdict confirmed what colonial psychiatry, especially the Algiers School, had argued for years and what much of French racism corroborated: “when you come down to it, the North African is a simulator, a liar, a malingerer, a sluggard, a thief” (p. 7). For Fanon, however, the pain described by these patients was not imaginary but all too real. As he contended, this illness did have symptoms but they were not necessarily physiological. He called it “the North African syndrome.”

Fanon’s essay on “The North African Syndrome” provides yet another confirmation of the interdependence of psyche and soma, of medicine and politics. As Fanon (1967) put it: “it so happens that there is a connection” between “the North African on the threshold of the French Nation” and “the North African in a hospital setting”:

Threatened in his affectivity, threatened in his social activity, threatened in his membership in the community [appartenance à la cité]—the North African combines all the conditions that make a sick man. Without a family, without love, without human relations, without communion with the group, the first encounter with himself will occur in a neurotic mode, in a pathological mode; he will feel himself emptied, without life, in a bodily struggle with death, a death on this side of death, a death in life.

(p. 13)

As this passage makes clear, the existence of these real-yet-imaginary illnesses displayed by North African immigrants confirmed with striking clarity the structural effects of racism and discrimination on the psyche.

“The North African Syndrome” first appeared in 1952 in the left-leaning Social-Catholic journal Esprit where Fanon had published a few months earlier another essay, “The Lived Experience of the Black Man”—which eventually became the fifth chapter of Black Skin, White Masks. These two Esprit articles gave Fanon wide exposure as they brought his ideas out of the world of psychiatry into the mainstream French intellectual scene and into a broader conversation around racism, colonialism, and psychiatry. Indeed, Esprit had been critical not only of French colonial policy but also of mainstream psychiatry, as evidenced by its December 1952 issue titled “The Misery of Psychiatry” to which Lucien Bonnafé, François Tosquelles, Georges Daumézon, Louis Le Guillant and other “radical psychiatrists” associated with Saint-Alban had contributed. It was through Esprit that Fanon eventually found a publisher for Black Skin, White Masks (originally titled “Essay for the Disalienation of the Black Man”) which Jean-Marie Domenach, the journal’s editor-in-chief, passed on to Francis Jeanson at the Éditions du Seuil and which appeared in French bookstores in the spring of 1952.

Fanon wrote Black Skin, White Masks while he was finishing medical school. As he indicates in one of his early chapters, his original idea was to submit the manuscript as his medical thesis but Dechaume was quick to reject it on the predictable grounds that it defied all existing academic and scientific norms (Macey, 2012, pp. 136–137). It is in this context that Fanon turned to the more conventional topic of Friedreich’s disease, somewhat reluctantly and hastily, so that he could graduate. As his initial title suggests, the question of “disalienation”—with its double meaning in French as a political and psychic process—was at the heart of Black Skin, White Masks. As Fanon wrote in his introduction (2008), even though his analysis was primarily psychological, “it remains, nevertheless, evident that … the true disalienation of the black man implies a brutal awareness of the social and economic realities” (p. xiv). If racism did indeed produce an inferiority complex, Fanon continued, it began as an economic process that was later internalized, “epidermalized”—inscribed in the body and in the skin.

In Black Skin, White Masks like in his medical thesis and in his article on “The North African Syndrome,” Fanon turned to a wide array of texts and disciplines to study the phenomenon of racial alienation. He referred to his book as a “clinical study” and in that sense, we can read it in line with these two other works, as a complementary text, as three attempts to explore the question of causality in mental illness and to elaborate a theory of subjectivity that drew on psychiatry, psychoanalysis, phenomenology, and politics. Fanon’s subject was defined by a structure of conscious and unconscious relations rather than by biological essentialism or brain chemistry. This structural analysis allowed Fanon to highlight the importance of the social (especially of structural racism) but also of alterity, of others, ...

Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• Dedication
• Contents
• Preface and Acknowledgements
• Introduction
• SECTION 1 Fanon’s Clinical Work in Historical Context
• SECTION 2 History, Theory and Fanonian Praxis
• SECTION 3 Fanon in Clinical Action: Psychotherapeutic and Community Applications
• SECTION 4 Fanonian Research in Action
• List of Contributors
• Index