FRANTZ FANONS CLINICAL STUDIES

(1954-1960)

BY
MAZI A. ALLEN
BA, Saint Marys College (CA), 1999
MA, Binghamton University, 2002

DISSERTATION
Submitted in partial fulfillment of the requirements for
the degree of Doctor of Philosophy in Philosophy, Interpretation, and Culture
in the Graduate School of
Binghamton University
State University of New York
2011

UMI Number: 3465741

All rights reserved

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Accepted in partial fulfillment of the requirements for

the degree of Doctor of Philosophy in Philosophy, Interpretation, and Culture
in the Graduate School of
Binghamton University
State University of New York
2011
May 6, 2011
Mara Lugones, Chair
Program in Philosophy, Interpretation, and Culture, Binghamton University
William Haver, Member
Program in Philosophy, Interpretation, and Culture, Binghamton University
Michael Hames-Garca, Member
Department of Ethnic Studies, University of Oregon
Darryl C. Thomas, Outside Examiner
African and African-American Studies, Pennsylvania State University
iii

Abstract
Between 1954 and 1960, Frantz Fanon conducted numerous clinical studies on the
social role of psychiatry (in his capacity as director of psychiatric wards in French
Algeria and later post- independence Tunisia.) Later published as articles, conference
papers and lectures, these studies eight of which are translated in this dissertation for
the very first time ask us to consider the possibility of constituting community from a
non-antagonistic basis. Whereas previous political theory has presupposed antagonism
towards the other offering the choice of either rendering the other transparent (in
terms of fitting them into ones understanding of the world) or else conflict Fanon asks
us to consider whether we cannot move beyond such self-centered understanding of the
world and actually know the other as such. In reading these studies in conjunction with
Fanons better-known work, I will trace the development of this alternative vision of
community from its origins in Black Skin, White Masks and will argue that Fanons
attempt to reconceive of community from a non-antagonistic basis constitutes a central
them in his thought linking both his professional and political commitments.

iv

Acknowledgements
In making this dissertation possible, I acknowledge God (or whatever name one
uses to designate that Higher Power or not), the Allen, Turner, and Gibson families
(as well as the rest of my extended family), my committee members (Mara Lugones, Bill
Haver, Michael Hames-Garca, and Darryl Thomas), other faculty members at
Binghamton University who provided various forms of moral and material support to this
project (including Michael West, Joshua Price, and Stephen David Ross), the staff in the
Bartle Library (including Aynur De Rouen), the staff of the PIC Program (Jeanne
Constable and Donna Young), and far too many friends and associates to name (included
a certain tuxedo-printed tortoise-shell domestic shorthair cat who responded to the
name of Miss Kitty ....)

Table of Contents
Introduction
Chapter 1 States of Exception
Section 1 The Broussais Principle..................................................................................1
Section 2 Natural History................................................................................................7
Subsection 1 The Geoffroy-Cuvier Debates..............................................................8
Subsection 2 tienne Serres and the Institutionalizing of French Anthropology....10
Section 3 Morel and Degeneracy Theory.....................................................................13
Section 4 Criminology and the Lyon School................................................................15
Section 5 Cette Algrie conquise et pacifie ........................................................18
Section 6 Porot and the Emergence of the Algiers School...........................................21
Chapter 2 The Politics of Internment
Section 1 Isolment.......................................................................................................25
Section 2 The Parisian Asylum Infrastructure..............................................................27
Section 3 The Lpine Committee.................................................................................30
Chapter 3 The Early Fanon and Psychiatry
Section 1 The North African Syndrome....................................................................35
Section 2 Black Skin, White Masks..............................................................................37
Chapter 4 A Critical Introduction to Fanons Clinical Studies..........................................45
Section 1 Fanon and Tosquelles....................................................................................46
Section 2 The Rationale................................................................................................48
Section 3 Failure to Identify the Social.........................................................................54
Section 4 Vicious Communities....................................................................................58
vi

Conclusion.........................................................................................................................68
Appendices: Frantz Fanons Clinical Studies (1954-1960)...............................................76
Appendix A: Sociotherapy on a Muslim Mens Ward: Methodological Difficulties....77
Appendix B: The Conduct of Confession in North Africa...........................................99
Appendix C: Current Aspects of Psychiatric Care in Algeria.....................................104
Appendix D: The T. A. T. Amongst Muslim Women: Sociology of Perception and
Imagination...........................................................................................115
Appendix E: The Maghribi Muslim Attitude Towards Madness...............................121
Appendix F: The Phenomenon of Agitation in the Psychiatric Milieu: General
Considerations Psychopathological Significance..............................127
Appendix G: Day-Hospitalization in Psychiatry: Its Value and Limits
Part I: General
Introduction..........................................................................................137
Part II: Doctrinal Considerations.....................................................................153
Appendix H: Encounter of Society and Psychiatry....................................................169
Notes................................................................................................................................184
Bibliography.....................................................................................................................197

vii

Introduction
The political, according to Carl Schmitt, comprises of decisions made on the
status of friend and enemy in the public realm. 1 In this sense, psychiatry has always
been political as psychiatrists have traditionally decided upon such status in the case
of the mentally ill. During the mid-20th century, however, this changed as psychiatry
began its third revolution which attempted to move psychiatry away from its previous
carceral character and thereby restructure the psychiatric hospital as a therapeutic
community (in which physicians and patients worked towards the single goal of
reintegrating the patient into society.) Culminating with the move towards
deinstitutionalization and finally antipsychiatry, the third psychiatric revolution seriously
challenged the relation Western societies had towards those who (for whatever reason)
were considered maladjusted or mentally ill. In relation to this movement, I will
argue that Fanons involvement was significant in that his examination of the
possibilities of such a therapeutic community during his directorship at psychiatric
units in Algeria and Tunisia raised interesting questions about the possibilities of
constituting community on a nondominant 2 basis.
Beginning in Chapter 1, the origins of degeneracy theory the theory which held
that mental illness was an inherent hereditary characteristic of the mentally ill will be
examined. It was this theory which, in the hands of French medical professionals, was
used to justify the view that mental illness in society created a state of exception which
had to be addressed by means of institutionalizing the ill. Thus its origins will be traced
1

from their beginnings in the failure of the Broussais Principle 3 in the 1840s, to its
development within the discipline of anthropology during the 19 th century and finally
criminology near the turn of the last century. As well, attention will be paid to the place
of the colonized North African within this larger medical discourse surrounding mental
illness especially in light of the fact that Algeria had been colonized by France at very
time degeneracy theory was taking shape in French medical discourse.
Keeping with this theme, Chapter 2 will deal with the institutionalization of the
mentally ill in light of the supposed state of exception caused by their presence in society.
Not only will the Loi sur les alins of 1838 (which established both the state-run
asylums and the psychiatric profession in France) be examined but also significantly to
Fanons career the role of psychiatrist Antoine Porot in the development of the North
African mental health infrastructure will be examined as well. Although Porot is better
known as an advocate of scientific racism, we will also examine his contributions to
psychiatry including that of placing psychiatric wards in non-specialist hospitals
(something he pioneered in colonial Tunisia, starting in 1909.) Again, attention will be
paid to the means by which society (in this case French) not only changed its own legal
definitions of insanity but (especially in the colonies) also took extralegal measures
even if progressive in nature in addressing it.
With this in mind, then, in Chapter 3 we will read Fanons earliest works
concerning psychiatric practice the article North African Syndrome and Black Skin,
White Masks (which was originally intended as the thesis portion of his medical degree)
in terms of the questions they raised about the previous history of French psychiatry as
well as broader conceptions of community. Chapter 4, finally, will consist in a critical
2

reading of Fanons clinical studies (divided into three groups.) The first group
consisting of The Maghribi Muslim Attitude Towards Madness (1956), The
Phenomenon of Agitation in the Psychiatric Milieu (1957), and Day-Hospitalization in
Psychiatry: Its Value and Limits (1959) will lay out Fanons rationale for embracing
the goals of the third psychiatric revolution and seeking a dialectical engagement with
the patient (as opposed to viewing them as enemies to be contained.) A second group
consisting of Sociotherapy on a Ward for Muslim Men (1954) and The T.A.T. among
Muslim Women (1956) will illustrate the problems posed (in terms of the physician
and patients mutual recognition) by the physicians misidentification of the forms of
sociality appropriate to their patients. As this identification of forms of sociality was
essential to Tosquelles notions of sociotherapy (being that they relied upon such forms
of sociality in reorienting the patient towards life outside of the asylum), we thus find that
Fanon by rejecting the notion of universal norms of the social in favor of closely
engaging the patient on their own terms is making a political statement as to his own
views of engagement with the other as such. The third and final group of Fanons papers
consisting of The Conduct of Confession in North Africa (1955), Current Aspects of
Psychiatric Care in North Africa (1955) and The Encounter of Society and Psychiatry
(1959-60) will address the challenges posed by attempting to reintegrate persons into
societies where they are viewed either as objects to be worked to death, as enemies of
the people to be isolated and hunted down or as both (the last being the case of the
worker under surveillance in industrialized nations.) I will then summarize and conclude
by noting the significance of Fanons rejection of antagonism (as a basis of engagement)

for the broader field of political theory by contrasting his views with those that take
antagonism to be the initial basis of engaging the other.
The purpose of this dissertation is both to introduce Fanons clinical studies to a
wider audience and to examine the line of thought running through all of them: the
question of a non-antagonistic engagement with the other. In so doing, this dissertation
will not assert that Fanon was systematic democratic theorist whose thought has
surpassed those of the present day, nor even that he even elaborated his ideas on
community fully before his untimely death at the age of 36. What will be said is simply
that the clinical studies he produced as director of psychiatric wards in Algeria (and later
Tunisia) reveal an interesting line of thought very much in line with his more widelyavailable works that sought to rethink community in terms of a nondominant, nonantagonistic, engagement with the other. Pursuing this line of thought, in my opinion,
would add an interesting complement to the various ways in which pluralism is theorized
within present-day political theory.

Chapter 1
States of Exception
The Broussais Principle
Although later popularized by Auguste Comte as the founder of Positive
Pathology,4 Franois-Joseph-Victor Broussais was (for the most) part not an academic
but, instead, primarily associated with the military. Having received his doctorate from
Paris in 1803 (under Pinel), Broussais took the less glamorous path of joining the French
Armys medical corps and served there (under Napoleon), until 1814. 5 With the fall of
Napoleon, he returned to Paris and began teaching at the Val-de-Grce Military Hospital
becoming mdcin-chef (that is, clinical director) in 1820. 6 Although he was later
Chair of Pathology and Therapeutics at the University of Paris, 7 it was at Val-de-Grce
where Broussais most important works were written.
In an era of instability where (on average) France changed its form of government
every 13 years, the military and not civilian or state institutions provided the
stability upon which the freedom to explore new ideas rested. Whereas the University of
Pariss Medical Faculty was actually closed in 1822 as radicals like Pinel were
retired by the Bourbon regime and suitably conservative professors were sought to
replace them military institutions (like Val-de-Grce) remained largely untouched (and
for good reason.) Thus it was that Broussais, safely under the French militarys
protection8 was thus able to express ideas that would have cost him dearly elsewhere.
These ideas (later termed physiological medicine) are best illustrated with regards to
5

mental illness in An Examination into Generally Adopted Medical Doctrines (1816) and
On Irritation and Madness (1826.)
An Examination was an attack on Pinels doctrines as well as those of the
University of Montpellier (from which Pinel derived much of his doctrine.) Especially,
Broussais took issue with the central premise of Montepelliers Hypocratic medicine:
the idea that disease affected the entire organism (as opposed to specific organs.) Hence,
as opposed to the Montpellier schools (and Pinels) nosological approach (which sought
to identify diseases in terms of symptomatology alone), Broussais held that disease
consisted in the excess or deficiency of stimulation of the different tissues.9 As Comte
would rephrase it, functional derangements cannot subsist without the lesion of organs
or rather tissues.10
Irritation (the work to which Comte explicitly refers) espoused the same doctrines
as the first, but was directed specifically towards mental illnesses. Even while noting the
relationship between the physical and moral characteristics of man as had also been
emphasized in Montpellier (and by Pinel) Broussais ideas about them were still quite
materialistic: The words reason, self, [and] conscience express nothing but the results of
activity in nervous matter in the brain.11 It was on this latter basis that Broussais, in his
later years, would advocate phrenology (with its claims of identifying the brains centers
of intelligence, criminality, and so forth.) 12
Simply stated, then, the Broussais Principle was that illness was present only if
there was a lesion in one of the bodys tissues, and as a steady stream of students were
taught by Broussais at the Val-de-Grce Military Hospital (with its protected military
status), this principle and the physiological medicine based on it would soon enter the
6

mainstream as the official doctrine of the French Armys medical corps. Vigorously
defended ... developed and applied in various articles, pamphlets, and books
published by doctors in the armed forces, 13 its application even spread into the more
respectable circles of clinical medicine. Thus, as late as 1840, physicians like Scipion
Pinel (son of the more famous Pinel) even opined that the discovery of lesions associated
with madness was only a matter of better surgical techniques. 14 In the finding of such
lesions associated with mental illness one would thereby answer all questions
concerning madness.
By the middle of the 1840s, however even as the surgical methods of
interrogation were perfected to exacting precision there were still cases where known
madmen (upon being autopsied) were found to have perfectly normal brains. 15 Such
findings left alienists medicine (as psychiatry was then called) scrambling. Some
alienists even resorted to fanciful explanations of what became of the lesions on such
obviously diseased brains. 16 The solution, however, was to be found in an idea which
(at the time) appeared to have been almost universally discredited.
Natural History
The discipline of natural history began in France as early as 1626 when the Jardin
des Plantes was established in Paris in order to provide an alternative to the outdated
medicine training of the University of Paris. 17 At the Jardin des Plantes, prospective
doctors would learn the science of medicine through actual, hands on, experience with
botany, chemistry, and anatomy (training which was, indeed, already available at
Montpellier.) 18

However, as the century progressed, medicine in Paris remained as

conservative as ever and the Jardin des Plantes moved further away from the medicine
7

until in 1739 a non-physician (Georges-Louis Leclerc, Comte du Buffon) was appointed

intendant of the Jardin by Louis XV. 19
However, with the advent of the Revolution, the Jardin des Plantes was not
disestablished (as were other institutes of the ancien rgime, such as the Royal Society
for Medicine.) This was due to an excellent public relations campaign (including free,
public, lectures) dating back to Buffon20 and convenient revelations of revolutionary
sympathies on the part of the Jardins professors. In fact, they even reformed the
institution along more Republican lines and, for instance, abolished the post of
intendant.21 Having gained the favor of the National Assembly, the Jardin des Plantes
(re-established as the Museum of Natural History) survived the Revolution with nearly
as much patronage as it had had during the ancien rgime. 22 In its new incarnation, it
would exert an enormous influence upon the theoretical direction of the life sciences
throughout the 19th century especially in terms of the debate between tienne Geoffroy
Saint-Hillaire and Georges Cuvier during the late 1820s and 1830s.
The Geoffroy-Cuvier Debates
Long before Darwins discoveries, the Geoffroy-Cuvier debates before the French
Academy of Sciences (c.1829-1832) laid the foundation for the evolutionary theories
which would predominate within France well into the 19th century. Indeed, their subject
concerned a central question in the biological sciences (which is even discussed to this
day, in one form or another): the question of whether sentient life forms developed
according to a single pattern of development or according to many. 23 In terms of
psychiatry, this question would take on a considerable importance during the decades
which followed.
8

On the one side of the debate, tienne Geoffroy Saint-Hillaire, Professor of

Mammal and Avian Zoology at the Museum, took the stance that sentient life developed
according to a single plan. Drawing on the views of Lamarck, as well as on the various
homologies between animals and humans which had been noted as early as the 1770s,
Geoffroy thus held that non-human animals were merely deviations or arrests in
development from Gods original plan (which, incidentally, was that of Mankind.) 24
Opposing this view was Georges Cuvier. A critic of Lamarcks, Cuvier (Professor of
Comparative Anatomy at the Museum) argued that animals were designed by God to
fulfill certain, specific functions. 25 Hence, for Cuvier, it was beyond question that such
animals were all necessarily structured along different plans according to their divinely
ordained function.
The importance of noting their use of God and empirical science is the fact that
both Geoffroy and Cuvier were equally oriented towards the evidence presented by the
available data (unlike todays creationists) yet both were also theists (unlik e many of
todays evolutionists.) In fact, Geoffroys argument referred to the many
teratologolgical instances within nature 26 (for instance, vestigial limbs, extra fingers and
such) in an attempt to refute Cuviers notions that all life forms served a useful
function. However, most members of the Academy of Sciences were more convinced by
Cuviers observations and thus (as the years) progressed, Geoffroy was increasingly
marginalized within the sciences as a poet and philosopher whose work was not worthy
of consideration by serious scientific publications. 27 Cuvier, on the other hand, would
enjoy posthumous fame as the exemplary scientist of his age (well into the 1880s.) 28
Although Cuvier had seemingly triumphed, Geoffroys followers recuperate his ideas by
9

applying them specifically to mankind: chief amongst these followers was tienne
Serres.
tienne Serres and the Institutionalizing of French Anthropology
Antoine-tienne-Reynaud-Augustin Serres (1786-1869) was himself a very
accomplished scientist. Having completed a medical degree at the University of Paris in
1810, Serres went on to the conduct clinical studies at the Hpital de la Piti which,
even in the 1810s, was becoming well-known in the field of neurology. 29 Having
performed numerous dissections, he was appointed mdcin-chef of the hospital in 1822.
Six years later, he was elected to the Academy of Sciences (under the Medicine and
Surgery section.) 30 Hence, by the time of the Geoffroy-Cuvier debates, Serres was
already an influential member of the French scientific establishment. However, he had
also supplemented his training through attended lectures at the Museum of Natural
History and with courses in comparative anatomy at the cole Pratique de Medecine (the
University of Paris Medical Facultys training facility.) Convinced by Geoffroys
arguments in favor of a single plan, Serres adopted the formers doctrines 31 arguing for
them forcefully in an 1818 paper on the development of the human brain (which won half
of a prize offered by the Academy of Sciences.) 32
Subsequently, Serres articles would attempt to illustrate how (in the various stages
of fetal development) the human being successively developed through stages which
resembled the adult forms of lower animals (conclusively proving, so he thought, the
correctness of Geoffroys hypothesis.) Having previously been passed over for the
Museums Chair in the Anatomy of Man in 1832, 33 Serres was appointed in 1839 (when
the previous occupant moved on to the Chair in Comparative Anatomy) and as Chair in
10

the Anatomy (and now also Natural History) of Man, Serres would continue to apply
Geoffroys notions but now only to human beings. This included using anatomical
specimens, portraits, and even photographs, to illustrate the physical characteristics of
diverse racial types (which he had obtained through his capacity as editor of
anthropological publications for the French militarys Algerian Scientific Commission.) 34
In keeping with the ideas of arrested development inherited from Geoffroy, Serres
(as early as 1845) would state that animal- like characteristics were to be found in all
the inferior races.35 By 1848, when Serres had begun designating his own field of
inquiry as Anthropology, his lectures nonetheless affirmed Geoffroys principles
(although specifically applied to humans.) Hence, just as animals were arrests in
development and deviation from the divinely ordered model of Man, the inferior
races were also arrests and deviations from the optimal development of that Man the
Caucasian white man. In 1855, the year his Chair at the Museum was redesignated as
the Chair in Anthropology, Serres was appointed to the Chair in Comparative Anatomy
(where he would continue to lecture until his death in 1869) 36 but nothing had changed:
even in 1857 Serres would state explicitly that the brains of the Negro, Malay, [Native]
American, and Mongol were most likely arrested versions of the human brain found
in Caucasians. 37
Anthropological study in France thus effectively began (on the institutional level)
with Serres efforts to recuperate Geoffroys discredited doctrines. Discursively
transformed into hard science by Serres, anthropology was further institutionalized as
science by Paul Broca (1824-1880) with his founding (in 1859) of the Paris
Anthropological Society. With eighteen other physicians specializing in the fields of
11

mental medicine, medical and experimental physiology, statistics, medical geography,

teratology, hygiene, anatomy and surgery, natural history, and general medicine, Broca
formed this society in order to address their shared interest in human variation and, in
particular, the social consequences of human hybridity. 38 As late as 1890, physicians
would continue to form the bulk of membership in Brocas society. 39 Although Broca
and his colleagues cited Serres, they added a quantitative orientation to the study of
man (further entrenching it within the sciences.) This quantitative emphasis could be
traced to Brocas mentor Franois Leuret (1797-1851), an influential alienist taught by
Jean- tienne-Dominique Esquirol (of whom we will hear more about later.)
Leuret had attempted to apply the findings of natural history to the study of
human intelligence and as early as 1839 had concluded (amongst other things) that the
distinction between human intelligence and animal instinct was fallacious. 40 Some
animals exhibited forethought, he contended, while many humans (particularly criminals)
tended to operate according to uniformities usually designated as instinct. The
evidence for the latter being obtained was obtained from statistics, such determinist views
on human behavior would later be reiterated (on the same basis) by criminologist Gabriel
Tarde and other members of the later Lyon School of criminology. Most importantly,
however, Leurets criticism of phrenology was based on its carelessness in quantitatively
examining skulls. 41 Applying Leurets quantitative emphasis to anthropology, then,
Broca sought to apply careful numeric indexing to the measurement of human skulls and
brains in order to provide solid evidence of the animal- like features referred to by
Serres. Above all, Brocas new physical anthropology sought explanations for human

12

mental and behavioral phenomena within such highly specific physical structures as
the brains and skulls he measured. 42
Accordingly, then, given that physical organization and especially
craniological characteristics determined mental capacities, the capacity for moving up
the ladder of civilization could be scientifically determined by examining features of
the cerebral-nervous system in terms of presence or absence, development or
retardation, simplicity or complexity ... of those features. 43 Having derived from the
increasingly obsolete discipline of natural history, the new discipline of physical
anthropology (with its emphasis on the fundamental organization of highly specific
physical structures) had shown how human beings developed, evolved, and could be
arrested in their development. Thus the previously discredited notions of Geoffroy and
Lamarck, recuperated and repackaged as solid, empirically-based science, now provided
the foundation for a perfectly rational, quantifiable, explanation for mental illness that
had eluded the advocates of the physiological medicine.
Morel and Degeneracy Theory
Around the same time Broca was organizing the Paris Anthropological Society,
Dr. Bndict Morel (1809-1873) was completing a comparative study of working-class
Rouen and surrounding villages which would become his Treatise on the Physical,
Intellectual, and Moral Degeneration of the Human Species. In that work, Morel stated
that alcoholism, immorality, poor diet, and unhealthy domestic and occupational
conditions set in motion a series of conditions which (eventually becoming fixed
patterns of behavior) soon characterized the lineage of some families. 44 Such
behavioral patterns thus arrested the optimal development of man and, being inherited by
13

offspring (in Lamarckian fashion), resulted in a flawed nervous constitution in the person
known as a neuropathic diathesis.45 Over time, specifically over the course of four
generations, such diatheses would manifest themselves in the forms of neurosis, mental
alienation, imbecility, idiocy and [finally] sterility ....46 Hence, the pathological
behavior of such degenerates was not the result of a lesion on a specific portion of the
brain, concluded Morel: rather, the apparently undamaged brains of such known
madmen were part of a damaged nervous system and pathology was the normal state of
such people.
By 1859, after publishing several articles endorsing Morels view, alienist
Jacques-Joseph Moreau de Tours (a physician at the Salptrire Hospital) would publish
his own work on the subject Morbid Psychology and its Relation to the Philosophy of
History in which he stated that the entire nervous systems of such hereditary madmen
constituted a dynamic nervous lesion.47 Later, Morel further clarified his position in
the 1861 issue of Annales mdico-psychologiques: not only were there hereditary
madmen, but certain actually lived amongst us. Although behaving and thinking
erratically, stated Morel, they were rarely believed to be mad. These lucid e alins
thus posed a grave danger to society as they had a tendency to:
... upset the order of everyday life with their alcoholism, kleptomania,
sexual perversions, suicidal tendencies, defiance of constituted authority,
and sporadic violence.
Only through recognizing such reasoning insanity could society better defend itself
from the sinister, irresistible impulses caused by damaged nervous systems. 48 In the
following decades, these theories would solidify within the field of criminology.

14

Criminology and the Lyon School

The legal system in France (throughout the 19th century and even well into the
1950s) operated according to the inquisitorial model of judicial procedure. Although this
mode of judicial procedure dated back to Roman times, it was only officially instituted in
France (by Louis XIV) with the Ordinance of 1670. 49 As opposed to the adversarial
model familiar in Anglo-American nations, the accused under the inquisitorial model had
few (if any) rights. In fact, until 1897, the accused in France had neither the right to legal
counsel, nor to be informed of the charges against them, nor even to confront their
accusers. 50 Only the submission to the trial judge of letters and memoirs concerning the
life of the accused (dossiers in French legal terminology) were permitted. Although this
indeed changed after 1897 (with the passage of laws granting the accused more rights),
the accused were still at a disadvantage: for instance, even if they had a defense attorney,
their attorney could only speak if the trial judge granted permission. 51 In some cases,
even during jury trials, judges would often question the defendant at length (in effect
becoming prosecutors.) Practically speaking, all of this meant that the accused was
presumed guilty.
In connection with this, the use of psychiatrists as expert witnesses dated to the
code dinstruction criminelle of 1808 which specified the conditions under which a
physician could be called to aid the detection and solution of crime, 52 as well as the
Napoleonic Penal Code of 1810 which held that the mentally ill could not be held
responsible for their crimes. 53 The Napoleonic Code further granted judges discretion
in determining sanity. When interdiction proceedings were abolished by the Law of
1838, the determination of sanity was effectively removed from the jurisprudential and
15

into the medical realm (specifically into what came to be called medico- legal practice or
legal medicine.) As far as the use of psychiatrists as expert witnesses was concerned,
nothing had changed. Thus the field of legal medicine (and hence psychiatry) became of
interest to criminologists in the late 19th century and one of the more significant debates
in this regard occurred around 1885 between Csare Lombrosos Italian criminological
school and Alexandre Lacassagnes Lyon School.
The Italian School of criminology, framed within the distinct racial conflict
between the Northern and Southern portions of Italy, 54 conceived of the criminal in terms
of gross physiology. The criminal was a physical type characterized by such things as
irregular teeth, large jaws, dark facial hair, and twisted noses all of which indicated an
instinctive urge towards antisocial behavior. 55 Borrowing both from Darwinian
evolution and Morels account of degeneracy, 56 Lombrosos conceived of this born
criminal as being a reversion to an atavistic ... ancestral type 57 of human being.
However, as Lombroso viewed non-whites, in general, as representative of previous
stages in human evolution (with Blacks being the earliest and hence most primitive), 58
this view had obvious racial overtones: criminal tendencies, in short, were indicated by a
predominance of ostensibly Negroid features. In opposing the Italian School, the
French Lyon School would arrive at a more convincing, yet far more insidious,
conclusion.
The Lyon School59 represented by Alexandre Lacassagne (Professor of Legal
Medicine at the University of Lyon) and his frequent collaborator Jean-Gabriel de Tarde
(juge dinstruction in the Dordogne region of France and later Professor of Modern
Philosophy at the Collge de France) 60 held that the criminal could, by all indications,
16

appear to be a normal (that is, Caucasian) human being. Their only difference would be
the lack of the moral sensibility found in normal persons. Tarde even asserted that
such criminal would have been hunted down like a wild beast straying into our streets 61
were it not for his close resemblance to us. However, echoing Cuvier's position in the
Geoffroy-Cuvier debates, the Lyon Schools emphasis was not on the morphological
difference of the criminal but on their function.
For Tarde especially, society served a primarily assimilative functio n based on the
imitation of dominant cultural norms by the subordinate. 62 With their charismatic
personalities, criminals lacking moral sensibility due to his fatally flawed nervous
systems 63 threatened to undermine civilization itself through being imitated by their
associates until they (as it were) had the whole of society under their spell (engaged in
subversive criminal acts.) Lacassagne himself put it thus: the criminal, like a single
microbe within a fermenting broth,64 can potentially infect the whole of society
with their behaviors. Thus the Lyonnais criminal far more dangerous than the readily
identifiable Italian atavist, as he was not only a dangerous subversive but also virtually
indistinguishable from the average, civilized, European.
Yet, precisely because they lacked moral sensibility in their normal functioning
state that is, when having no sign of brain damage or developmental disability these
criminals could be held responsible for their actions. In Tardes words, they could be
punished for acting upon their unfortunate criminal impulses just as someone born
stupid (without disability) could be ridiculed for their unfortunate lack of common
sense. 65 Hence, for Lyonnais criminology, penalties served the didactic and deterrent
functions of both making an example of the criminal (for society at large) and of
17

deterring potential criminals from acting on their unfortunate impulses. 66 By the end of
the 19th century, then, the disciplines of anthropology and psychiatry had joined forces
and (as the discipline of criminology) had become an instrument by which social norms
were enforced and the distinction between friend and enemy maintained. However,
one further element deserves particular attention: Frances colonial involvement in
Algeria.
Cette Algrie conquise et pacifie .
Since its conquest, Algeria (for France) had been a frontier settlement within their
colonial empire. While other colonies were clearly used for their resources and cheap
labor, Algeria (like the American West) was not only exploited in such ways but also
open to French, Spanish, Maltese, Italian (and Corsican ...) 67 settlers who, in exchange
for plots of vacant arable land, would set about the task of recreating French
civilization. However, there was an even more sinister element in this already bleak
situation, which Fanon himself described quite eloquently:
... Jean-Paul Sartre ... has shown that on the level of the unconscious,
the Jewish woman almost always has an aura of rape about her.
The history of the French conquest of Algeria, including the
overrunning of villages by troops, the confiscation of property and the
raping of women, the pillaging of the country, has contributed to the birth
and crystallization of the same dynamic image. At the level of the
psychological strata of the occupier, the evocation of this freedom given to
the sadism of the conqueror, to his eroticism, creates ... fertile gaps
through which dreamlike forms of behavior and ... criminal acts can
emerge. 68
Such images had indeed been with Algeria since 1830, taking on various forms of
expression: from the fantasies of the military recruit dreaming of treasure and
odalisques,69 to the actual rape, mutilation, and murder of Algerian women by the
French conquerors, 70 to pronouncements by colonial administrators advocating the use of
18

the fertile wombs of Kabyle 71 girls to perpetuate European settlement in Algeria 72 all
of which were extensively documented (even in contemporary sources.) However,
mainland anthropological discourse would also have ramifications for Algerias
colonization.
Not only had tienne Serres been employed by the French military as editor of the
Algerian Scientific Commissions anthropological publications acquiring, in the
process, drawings and photographs of the racial types of that country but, with French
anthropological discourse rigorously applied to the colonies, populations were divided
and classified according the premise that the Arab was one of those lower animallike races incapable of moving up the ladder of civilization. Already dehumanized
through the conquest itself (especially in the case of the Arab woman), the Arab was
further dehumanized within French medico- legal practice. For instance, physician
Adolph Kocher whose medical thesis was approved by the University of Lyon in
188473 (precisely during the same time period Lacassagne was Professor) 74 stated that
the North African Arab was not only naturally predisposed to violent crime as a
function of his race and culture but that Like all Oriental peoples, the Arab was a
sodomite and practitioner of bestiality known to have relations with goats, sheep, and
even mares .... 75 All of this was based on statistics obtained from none other than the
Algiers Cour dAssises which (even at the time) was known for its 90 percent conviction
rate for North Africans. 76 Modern psychiatric care (on the other hand) would not exist in
Algeria until 1933 77 (or on an official basis until 1938) 78 and thus, during all of the 19th
century (and a significant part of the 20th), the mentally ill were dealt with by merely
shipping them to asylums in southern France.
19

For the North African, this internment involved being shipped across the
Mediterranean in steerage, subjected to a diet that included pork and wine when they
arrived in France (things forbidden to practicing Muslims), and often being left in
straitjacketed in cages while their guards drank and socialized. 79 This combined abuse
and neglect inevitably made recovery impossible and a staggering 49% percent of the
North Africans in French asylums died within a year their arrival. Yet, at the height of
this overseas internment (in 1896), Dr. Abel-Joseph Meilhon director of the asylum at
Aix-en-Provence (where many of these North Africans would be sent) asserted race
dominates all psychopathology for the Algerian native and that the cerebral
inferiority80 of the North African was such that it was only found ... amongst the most
inferior [European] degenerates.81
By the end of the 19th century, however, the North African Arab had begun to
acquire the characteristics of both the Lombrosian and Lyonnais criminal at once a
recognizable atavist but also possessing the ability to contaminate the public sphere with
his primitive mores. Aside from the ranting of certain physicians that Islam itself was a
mental illness,82 most French scientific racists of the turn of the century were decidedly
organicist and quantitatively oriented in their approach (taking their cues from Drs.
Serres and Broca.) During the early 20th century, the most vigorous proponents of such
ideas were the followers of Dr. Antoine Porot at the University of Algiers (where Porot
was Chair of Neuropsychiatry from 1925-c. 1955.)83 The same Porot, however, was also
the progressive- minded physician who sought to bring psychiatry in North Africa into the
20th century.

20

Porot and the Eme rgence of the Algiers School

Antoine Porot (1876-1965), born in Chalons-sur-Sane (just north of Lyon), was
trained in the University of Lyons medical faculty around the turn of the 20th century.
Having completed a thesis in 1904 on the use of mercury in treating tertiary syphilis of
the nervous system, he interned with psychiatrist Jean Lpine, 84 leading to an interest in
colonial psychiatry. The two would later collaborate in a fact- finding committee which,
amongst other things, recommended the implementation of a two-tiered psychiatric
infrastructure for Algeria. After his appointment to Tunis in 1907, Porot went on to
organize an acute care open service facility at the French Civil Hospital (which was
fully operational by 1911.) 85 The first of its kind on French territory, this facility was
structured as a hospital ward with close observation b eing emphasized over restraint
(with visits from parents and other relatives being encouraged.) 86 However, by 1912, still
seeing that the shameful lack of psychiatric care in the French colonies was threatening
Frances civilizing mission, Porot submitted a report to the Congrs des medicins
alienistes et neurologistes de France et des pays de langue franais recommending
(amongst other things) the training of a medical corps capable of understanding Arabic
and ... the normal mentality of the Arab ....87 By 1915, he had been transferred to the
Maillot Military Hospital in Algiers and in 1925 was appointed C hair of Neuropsychiatry
at the University of Algiers. Even from Algiers, however, he was also instrumental in the
establishment of the Manouba Hospital for Mental Disease (1927) in a suburb of Tunis. 88
Although Porot is widely credited even by North Africans as being a reformer
who effectively argued for modern psychiatric services in North Africa, his legacy is by
and large overshadowed by his own racism (and that of his followers) 89 While they
21

argued for more and better psychiatric facilities in North Africa, Porot and his Algiers
School (as his followers were called) 90 also contended that an inherently inferior,
pathological, mentality characterized the North African. For instance, just shortly after
the First World War, Porot and psychoanalyst Angelo Hesnard co-authored texts entitled
Military Mental Expertise (1918) and The Psychiatry of War: A Clinical Study (1919.)
Beginning from the premise that each race has its own mental level and its own
complexion they went on to describe how on several occasions we have received ...
natives labeled mentally debilitated who were not, however, inferior to the mean of
their race.91 Further, the supposed inability of these natives to cope with the realities
of trench warfare was attributed to a generalized lack of initiative: unlike the settler
populations who struggled in an arduous climate and rendered an unforgivable land
fertile, the Muslim natives supposedly tolerated the miserable earth before them. 92
Added to this already prejudicial view of the North African were the armchair
observations of anthropologist Lucien Lvy-Bruhl.
Published in 1910, Lvy-Bruhls Mental Functioning in Primitive Societies (later
translated into English with the title How Natives Think) asserted that the primitive mind
was prelogical and governed by a law of participation wherein opposites freely
coexisted (bound together by mystical entities.) 93 Although this study was soon criticized
for its lack of methodological rigor (as Lvy-Bruhl had done no fieldwork) and
psychoanalysts had even pointed out how many civilized persons reconciled
contradiction in accordance to this supposed law the idea of the primitive-asillogical- irrational had already become so ingrained within French thought that the law
of participation was soon a widely accepted fact. 94 Thus, in 1932, Porot co-authored a
22

paper which stated, amongst other things, that the various settler-native conflicts in
Algeria were the direct result of the primitive mental apparatus of the Algerian (which
led to impulsive reactions in everyday situations.) 95 Thus, as with Morels degenerates,
the Algerian had a nervous system which respo nded pathologically to stimuli 96 and
(almost reiterating Tarde and the Lyon School to the letter) Porot and his co-author
asserted:
... it is above all through ... sanctions that we teach these [arrested] and
overly instinctive beings that human life must be respected ... a thankless
task in the general work of civilization. 97
The co-author of that paper, Don Cme Arrii, had (in 1925) been the first medical student
to graduate from the Algiers Medical Faculty and his thesis on the Criminal
Impulsivity of the Indigenous Algerian not only referred to North Africans by various
derogatory names but (addressing the need for an asylum in Algeria in terms of the North
Africans inherent criminality) argued for increased restrictions on North African
immigration to the French mainland. In particular, Arrii stated that the Algerians
propensity for crime proved once and for all that the Muslim native, who mingles ...
with our national life, brings the psychopathological heritage of his race to our
civilization.98 This was something which would, again, be echoed in medical theses
produced in Lyon as late as 1951. 99
Thus, although explicitly rejected by the early 20th century, Morels degeneracy
thesis (as re-articulated by the Lyon and Algiers Schools) would remain as an
undercurrent in both French psychiatry and legal medicine well into the 1950s.
Particularly in the colonies, the notion of degeneracy was deployed against the colonized
in the form of stating that the colonized were less evolved and thus inferior to the
23

French colonizers (physically, morally, and most of all psychologically.) 100 The
colonized elite, educated with such values, consequently came to believe that the closer
they were to the French (in any respect) the better. But what was to be done with all
those degenerates living amongst us, those wild beasts straying into our streets? The
problem of psychiatry had thus become one of addressing the states of exception
presented daily by the presence of mentally ill persons within society.

24

Chapter 2
The Politics of Internme nt
Isolment
Between 1829 and 1835, alienists increasingly placed themselves not only at the
forefront of the public hygiene movement (as in, for instance, Franois Leurets
involvement in founding Annales dhygiene publique et de mdecine lgale) but also
within the French government itself. 101 As with Broussais, alienists (as proponents of
public hygiene) advanced their arguments with the support of the French military. For
instance, Louis-Ren Villarm a physician (like Broussais) with close ties to the
Napoleonic Army had early on joined forces with Leuret to bring a determinist,
quantitative, focus to articles in Annales dhygiene publique. 102 Given the public hygiene
movements concern for moral liberty and the prevention of infanticide, suicide,
homicide, and other acts of violence against persons, 103 mental health soon became its
primary focus. In keeping with such concerns, Jean-tienne-Dominique Esquirol
addressed to the Institute of France in October of 1832.
Addressing the Institute of France on the need for state control over asylums,
Esquirol the preeminent French alienist of his day began by emphasizing the
necessity of isolation in the cure of mental illness. 104 Although his predecessor and
mentor Philippe Pinel saw isolation as merely a tool for the introduction of new
impressions to the patient, for Esquirol it had become a necessary element. 105 It was
through isolation that the basis was provided for such new impressions in the first place.
25

Only through removing the patient from the familiar settings which reinforced his
disordered thinking would the physician be able to introduce newer patterns of thought
into the patients mind. 106 Thus, seeing their environmental conditions as pathological,
Esquirol believed it was possible to restore balance by removing the patient from their
previous environment and into an asylum. Indeed, such asylums as existed at the time
were said to work wonders for their mostly well-to-do clientele. 107 Thus the provision of
institutional support for the construction of more asylums (as well as to alienist medicine
in general), then, was of the utmost urgency. But, one obstacle stood in the way of both:
a legal procedure known as interdiction.
Interdiction was a legal proceeding dating to the 15th century by which the
sanity of an individual was determined by the court. Following inquisitorial judicial
procedure, interdiction proceedings were conducted b y a magistrate who would gather
evidence in determining whether the person in question was able to manage their own
affairs.108 Interdiction thus involved lengthy questioning of the presumably insane
individual, their family, their associates, and so forth. Once it was determined that the
subject could not manage their own affairs, the magistrate would issue a writ of
interdiction which effectively pronounced the subject insane. In fact, most early asylums
would not admit patients without such a writ of interdiction. 109 However, such
proceedings could take years all the while with the presumed madman was allowed to
remain at large. Esquirol thus argued that interdiction needed at least to be separated
from the determination of mental illness (if not abolished altogether), 110 since the
determination of illness was outside the authority of [a] judge. 111 Although exceptions
were to be made in the case of those who were peaceably demented (and thus could be
26

left to their families), Esquirol firmly stated that the mentally ill of the lower classes
ought in general to be isolated, their relatives being deprived of all means of
surveillance .112
After Esquirols fairly well-received talk, legislation was soon proposed for a law
to address his concerns. Although some suspected that this legislation would place the
liberty of all individuals suspected of insanity at the mercy of administrative power,
the Loi sur les alins of June 30, 1838 was passed by a wide margin after six years of
lobbying and agitation by Esquirol and other alienists. 113 As stated above, it abolished
interdiction proceedings. However, it also provided that every department in France have
an asylum with the staff (including physicians) salaried by, and responsible to, the
Ministry of the Interior (or an equivalent official, in the case of the colonies.) Further,
such asylums would serve as teaching hospitals for alienists (either independently or in
association with a local university), establishing alienism (that is, psychiatry) as a
medical specialty in France. 114 However, it also originally provided that lunatics could
be confined by order of a departmental prefect and held in an asylum until a physician
recommended otherwise. Although this latter provision was amended by a decree issued
in 1845 (specifying that commitment could only be made with the agreement of an
examining physician), 115 confinement became increasingly permanent and the lunatic
increasingly the experimental object of psychiatry.
The Parisian Asylum Infrastructure
As the 1845 decree required a physicians diagnosis for commitment to an
asylum, a permanent medical post was assigned to the Dpot of the Paris ian Police
Prefecture shortly thereafter for the receiving and diagnosing of the presumed insane. 116
27

Given the emphasis placed by Ulysse Trlat (the first holder of this position) on the
hereditary aspects of mental illness, the Dpot soon became a key forum for observing
the links between madness, poverty, and crime. 117 In 1872, a Special Infirmary was
organized to better facilitate the work of the Dpot and thus the first line in Parisian
asylum infrastructure was established. By the 1930s, the Dpots Special Infirmary had
acquired a reputation as one of the premier centers of criminological stud y in France
(aside from Lyon) and figures associated with it included Drs. Getan Gatian de
Clrambault and Jacques Lacan. 118 Lacans thesis on Paranoid Psychosis, initially read
by those interested in legal medicine (for instance), was based in part on cases
encountered at the Special Infirmary. However, there was a second line.119
Since its expansion during the 1860s, the Sainte-Anne Hospital (previously the
hospital farm for the Bictre Hospital) 120 had become one of the sanctuaries of modern
science in France. 121 This was due in large part to the adoption of the positivist-inspired
medical research promoted by its longtime director Valentin Magnan. During his tenure,
Magnan (as head of the Bureau of Admissions for Sainte-Anne from 1867 until his
retirement in 1912) 122 would stress the importance of adopting a proactive attitude
towards medical research (as opposed to merely observing and following the course of
nature.) Thus experimentation under tightly controlled conditions would be the means by
which the scientist would confirm or refute hypotheses. 123 However, Magnan was also a
proponent of degeneracy theory taking the view that, since degeneracy was irreversible,
there was no hope of curing the mentally ill. 124 Thus, although its primary function was
to render a definitive diagnosis of the patients referred to it from the Special Infirmary,

28

the experimentalist stance of the Sainte-Anne Hospital would extend to human subjects
who (given the attitude of the Bureau of Admissions) would assuredly never leave.
Thus, not only was psychoanalysis employed there for the first time within a
French psychiatric facility (in 1921), 125 but around 1949 a drug cocktail used to sedate
patients during surgery at the Sidi Abdallah Naval Hospital (in Tunisia) was brought to
Saint-Anne (via the Val-de-Grce Military Hospital) for testing. 126 Consisting mainly of
antihistamines, it was further synthesized into a pharmaceutical and immediately tested
on Sainte-Annes patients. After numerous successes, including on patients found to be
unresponsive even to insulin therapy, Sainte-Annes director at the time (Jean Delay) and
his colleague Pierre Deniker decided to publish their findings. 127 Soon the manufacturing
rights for the drug were granted to the Rhne-Poulenc Corporation which subsequently
sent representatives as far away as the United States and Canada to promote the new drug
Largactil (which was later licensed to Smith-Kline who would market it in the Englishspeaking world as Thorazine.) 128
So finally, after being processed into the asylum infrastructure at the Special
Infirmary and classified by the observing physicians at Sainte-Anne, patients would be
sent to institutions of the third line. 129 If their troubles were deemed to originate in
treatable, organic, illnesses (encephalitis, for instance), they would be sent to the HtelDieu to be treated with the available remedies. For terminal cases, most often associated
with late-stage dementia, the Nanterre Hospice would serve as the final destination.
However, in the vast majority of cases, patients fell into neither category. Their fate was
to either remain at the Sainte-Anne Hospital for further observation (and testing) or to be
sent to other Parisian asylums (for instance, the Bictre and Salptrire Hospitals) where
29

again they would be observed and tested. The Parisian asylum infrastructure, with its
three lines of psychiatric facilities, is not only of interest in terms of its use in dealing
with the mental illness in Paris alone but also because it served as the model for the
mental health infrastructure in Algeria.
The Lpine Committee
As mentioned before, colonial authorities were content to ship Algerias mentally
ill off to French asylums during the 19th century. For them, it provided a perfect solution
which both mercifully removed the patient from the familys view and met the colonys
needs at a fair price.130 While such attitudes persisted until as late as 1929, the
transportation of Algerias mentally ill overseas was increasingly seen as an
embarrassment both in France and colonial Algeria itself. Having a significant
European settler population and priding itself on its European character, by 1920
Algeria still lacked any semblance of a psychiatric services infrastructure remotely
analogous to structures existing in the Metropole.131 By comparison, between the
years 1912 and 1919, the governments of less developed colonies like Madagascar and
French Indochina had already constructed asylums which each housed more than 100
patients.
Thus, around 1919, a committee organized by Governor Charles Lutaud
recommended the construction of an asylum near the rural town of Blida (to the south of
Algiers.) 132 The asylum was to be modeled on the Sainte-Anne Hospital in Paris, but
with one exception: the segregation of European patients from Algerians as Algerians
would require special infirmaries and sleeping quarters which would respond in a
quite particular way to their general behavior, their mores, and their civilization. 133
30

Being that the Algerians inherent difference was taken for granted, the need for such
segregation was merely an afterthought. 134 This proposal for a hospital of the type
characterized by Sainte-Anne, however, was never implemented and thus (in 1923)
another committee was formed headed by Professor Jean Lpine of Lyon and including
Antoine Porot, Lucien Reynaud (then-public health inspector-general) and Joseph Salige
(a member of the earlier Lutaud committee.) 135
Its mission being to enlighten the Administration [of Algeria] on the evolution of
new ideas and notions of assistance to psychopaths,136 the Lpine Committee proposed a
psychiatric infrastructure of two lines of facilities instead of a large, comprehensive,
asylum like Sainte-Anne. Notice, however, that this later model still (at least partially)
replicates the Parisian system to which Sainte-Anne belonged. In Algeria, however, the
first line would consist of facilities whose sole purpose was acute care and processing of
patients. These psychiatric wards would be located throughout the colony within general
hospitals, precisely because such hospitals operated outside the Law of 1838 and would
thereby avoid the stigmas (in the eyes of the public) of madness and degeneracy both of
which, in the Committees opinion, stood as an impediment to the early and
opportunistic treatment137 of psychiatric crises. A hospital location would also enable
the implementation of the open service model pioneered in 1911 by Porot.
As previously mentioned, this model sought to replace the concealment and
confinement of the asylum with that of the hospital ward inspected by physicians on an
hourly basis and allowing visits by friends and relatives of the patient. Heralded as being
symbolic ... of medical progressivism as early as 1909 (even while the French Civil
Hospital was still under construction in Tunis), 138 we still find this more medicalized
31

model of psychiatric care in use to this day. As in Tunis, this progressive model of
psychiatric care proposed for Algeria would be implemented within the experimental
milieu of the colonies long before it appeared in the metropole. 139 The second line,
however, was to be located in an official asylum: the Blida-Joineville Psychiatric
Hospital. Although operating within the Law of 1838, the Blida Psychiatric Hospital
would nevertheless model itself as a hospital (as opposed to the asylum) to the point of
having open-service wards to provide acute care services to the surrounding population.
With all of this, however, there was just one problem: the entire plan was illegal.
First of all, the Law of June 30, 1838 only recognized the treatment of mental
illnesses within asylums. 140 Although the Special Infirmary of the Paris Police Prefecture
had existed since 1872, and even served as a teaching facility, in every case actual
treatment of patients occurred in psychiatric hospitals like Sainte-Anne, Bictre, or
Salptrire. In the Lpine Committees model, however, psychiatric wards (in general
hospitals) would be authorized to treat acute psychoses. This legal issue was solved,
however, when Algerian Governor-General Jules Cardes a supporter of the
Committees work issued a general instruction in 1934 (having the force of law)
authorizing the operation of such first- line open services.141 The first of these hospitals
were located in the Oran and Constantine general hospitals, and at the Mustapha Hospital
in Algiers.
More significant than the de jure illegality of the Lpine Committees
recommendations, however, was the de facto illegality of their implementation. Even
with the quick fix provided by Cardes general instruction, the Lpine Committees
system was still illegal under the Law of 1838 for, as mandated by that law, every
32

department in France was to have a full-service asylum for the treatment of long-term
psychiatric patients 142 : yet Algeria, having been divided into three French departments
since 1848, 143 had only one such asylum (the Blida-Joinville Psychiatric Hospital.) This
was entirely due to the intransigence of the European settlers Legislative Assembly
(which initially saw the construction of a facility in Blida facility as sufficient to preserve
the honor and European character of the colony.) Given such intransigence, this
illegality was not dealt with but instead ignored (which, again, points directly to the
political character of the treatment of mental illness.)
However, when we consider that such methods as the treatment of the mentally ill
within non-psychiatric general or civil hospitals had been proposed in metropolitan
France as early as 1899 (but not implemented until nearly 40 years later), 144 all of this
takes on a great deal of significance. For while the French Civil Hospital had been fully
operating (inTunis) since 1911, and Lpine Committees system had been implemented
(at minimum capacity) as early as May of 1933, 145 it took until August 13, 1937 for
similar measures to even be proposed within France itself. 146 Hence it is quite true when
Bruno Latour states that the colonies served as the laboratories under whose controlled
conditions the efficacy of such methods considered far too radical within France 147 were
tested on populations outside of France proper. It was precisely the frontier status of
the colonies that permitted the employment of experimental such treatments within them
yet the colonys status as beyond the pale of French civilization also meant that the
settler-dominated Legislative Assembly would never agree to increase funding for
psychiatric facilities (although promises were made and proposals submitted year after
year.) By 1954, this intransigence had reached such a point that the five mdcins-chefs
33

(that is, clinical directors) of the Blida Psychiatric Hospital (Dequeker, Lacaton, Micucci,
Rame, and Frantz Fanon), would draft a letter protesting Current Aspects of Psychiatric
Care in Algeria (published in lInformation Psychiatrique the following year.) By that
time it was all too apparent that the psychiatric service infrastructure outlined by the
Lpine Committee would never be fully, legally, implemented in Algeria.

34

Chapter 3
The Early Fanon and Psychiatry
Frantz Fanon enters into this history with the publications the article The North
African Syndrome and of Black Skin, White Masks (both in 1952.) In these texts, his
primary concern was with the psychological effects of racism experienced on an
everyday basis. Let us first, then, speak a little about The North African Syndrome
which, written while a student in Lyon, nicely summarizes Fanons views concerning the
previous history of psychiatrys engagement with the colonized.
The North African Syndrome
In North African Syndrome, Fanon addressed the then-common misconception
amongst French medical professionals that North African immigrants were malingerers
who filled hospital beds that otherwise would have been used by French patients. 148 The
North African, according to such medical professionals, constituted a threat to the wellbeing of honest, hardworking, Frenchmen by pretending to be sick in order to take
advantage of the warmth and comfort of the hospital. As proof of this, such medical
professionals would appeal to the long-discredited Broussais Principle stating that since
these North Africans showed no physiological symptoms of illness, they were (therefore)
not ill. 149 Here, Fanon after deeming these physicians Neo-Hippocratic (comparing
them thus to those of the University of Montpellier in the mid-19th century which still
adhered to the Hippocratic notions of vital forces and humors long after these had
been discredited elsewhere) 150 went on to list more than half a dozen conditions in
35

which the patient could be seriously ill with the body appearing to have no physical
disturbance whatsoever. Stating that this resurrected Broussais Principle (which he
deemed Neo-Hippocratism) was not adhered to in any medical school where
physiology was taught, Fanon made the important point that this malingering Arab was
part of an oral tradtion nonetheless propagated by racists also who believed that
treating North Africans as children was also acceptable. 151
Yet this racism on the part of a few physicians was symptomatic of a more
widespread illness within French society thus Fanon decided to ask what it was to
experience life as a North African immigrant. After going through a list of diagnostic
questions about their interaction with others, their life story, and so forth, he concludes
that the North Africans experience in France was the experience of a progressive
depersonalization and lack of recognition. 152 To be a North African immigrant worker
(though technically not an immigrant, as much of North Africa consisted of French
colonies and protectorates) was to experience life where ones interactions with
Frenchmen consisted of being rendered invisible by them and being constantly bumped
into (as if one didnt exist); it consisted of being preoccupied with the search for the
precarious day- labor such immigrant workers (then and now, in France and in America)
are offered; it was the experience of being demonized (in the case of the North African,
as a rapist the history of such characterization dating at least to the 1880s) and of being
a second-class citizen who was threatened on all fronts ... without family, love, relations
with others, or identity in a social sense and reduced to a broken, pathetic, man who
arrives at the doctor s office, his voice cracking in despair, saying Doctor, Im going to

36

die!153 But what was it to personally experience such social alienation? This Fanon
explored in detail in Black Skin, White Masks.
Black Skin, White Masks
One can say that there are probably as many ways to read Black Skin, White
Masks as there are readers: some plausible, others not so much. In terms of its content,
the most plausible readings find a tension in this text between the subjective and the
objective (the first and third person, respectively.) While Fanon seeks to scientifically
examine the psychological effects of racism, the way he does so is clearly from the nonobjective first-person, firsthand account of such. Sylvia Wynter finds that such a
blending of the objective and subjective can go a long ways towards addressing questions
that have even plagued disciplinary philosophy (such as the problem posed by the
experience of inner life.) 154 In light of such readings, I propose that Black Skin, White
Maskss account of the social origins of psychological distress in Blacks of the French
Caribbean begins on an Hegelian trajectory but makes an abrupt shift to address racism as
a political. This happens precisely when Fanon examines his own attempt at seeking
recognition. In order to make this clearer, it shall be necessary to take a (very short,
reductive) detour into Alexandre Kojves interpretation of Hegels Phenomenology of
Spirit.
According to Kojves interpretation of Hegel (which would have been familiar to
Fanon) we find that with the use of language, in the very first instance, being identifies
its object of desire. 155 This object, being seeks to empty of its content, assimilate, and
substitute itself in its stead. 156 As such being was characterized by its essential
emptiness (or lack), this meant that it would always find itself in search of such
37

objects. 157 However, such constant search of desired objects was merely desire in the
sense of animal desire or hunger158 human desire was that which went beyond the
immediate need to the being. 159 In the first instance, human desire was that of
mastery the desire of the right to desire an object. 160 As such a right make no sense
without the existence of others competing for such right, the existence of other such
beings was implied in this humanizing desire and so too was their struggle for the right
to the object. 161 Although this is characterized as a life and death struggle in Hegel, it
turns out only to be a struggle for recognition. As this recognition cannot be obtained by
annihilating the other consciousness (but only by forcing the other to submit), the
struggle only continues until finally one side acknowledges the others right to the
object. 162 That side becomes the slave while the other becomes the master. In
working towards ends that transcend themselves, then, the master (fighting for the right
to acquire an object) and the slave (performing tasks for the sake of the master) are
humanized. This however presents a paradox for the master since, in being a master, he
cannot recognize the slave as anything other than a tool for acquiring and creating objects
of desire. 163 As with initial being in pursuit of objects of desire, the master must
continually be in pursuit of other desiring selves whom it will seek to reduce to
thinghood by mastering. 164 In terms of recognition, then, mastery is a dead end. The
slave, however, not only recognizes the master as a self but also through changing the
objective conditions of the world in the service of another is able to create the
conditions for the possibility of recommencing its struggle with the master.165
Black Skin, White Masks thus follows this Hegelian trajectory right up to the
fourth chapter. Beginning with the object of desire (whiteness) being named, 166
38

succeeding chapters show how the Black self seeks to fill the emptiness of its being
with the white object and assimilate the whiteness of the object as its own 167 and
finally the conflict between competing desires especially in terms of Fanons refutation
of Mannonis dependency complex.168 Had Fanon stuck to his Hegelian trajectory, a
possible end conclusion could have consisted of colonialism (and the white racism it
entailed) being characterized as an empty materialist pursuit which impoverished the
white (psychologically) whereas Black creativity in the arts, literature, sciences and other
fields could have been shown as a means of overcoming the colonial racism through
changing the objective conditions of the world. In fact, examples of creativity which
challenge notions of white supremacy actually do appear in the fifth chapter of Black
Skin, White Masks with quotations from Langston Hughes, 169 Aim Csaire, 170 Lopold
Senghor 171 and even Sartres preface to an anthology of Black and Malagasy poetry. 172
However, chapter five of Black Skin, White Masks, we find the Hegelian dialectic veering
off-course into a discussion of the political.
In chapter five, Fanon finds himself confronted by the statements Dirty nigger!
and Look, a Negro! His first explanation for what was at work in his reaction to those
statements was that he was being objectified. 173 Referring directly to Sartres Being and
Nothingness, he characterizes his existence as being that of one attacked by an antagonist
he could not name. 174 In a sense he was right, he was being rendered as something other
than human something outside or beyond the pale of the human and by an other
whom he could not similarly objectify. Yet objectification doesnt quite grasp what was
at work, for Fanons antagonists were clearly reacting against his seeking of their
recognition (instead of being oblivious to it.) Aside from a single, solitary, white woman
39

who was truly engaged in the objectification and pursuit of the handsome Negro she
saw in Fanon, there was no pursuit of the Black object with the whites (a nd those who
would become white) whatsoever. 175 Instead, there was outright rejection. 176
In terms of understanding what is at work, Nelson Maldonado- Torres (in his
recent text Against the War: Views from the Underside of Modernity) points us in a
helpful direction by noting the following:
The remembrance of the objectifying gaze of the child in the opening
lines of the Lived experience of the Blackintroduces a paradox in
Fanons text. The paradox consists in Fanon announcing the absence of
his interiority from the point of view of his interiority. The description and
remembrance of the event of the negation of Fanons interiority
presupposes precisely what is denied, an interiority .... 177
That is to say that Fanons at once first- and third-person account, which also figures
greatly in Wynters earlier piece, expresses a phenomenon described by AfricanAmerican social theorist W. E. B. du Bois some fifty years before: that of double
consciousness. With the idea of double consciousness, Du Bois addresses (from the
point of view of subjective experience) experience of antagonism towards AfricanAmericans particularly those descended from slaves emancipated in 1865 or earlier.
Being as thoroughly American (and even more so) than many European immigrants, they
were (and are still) viewed as outsiders nonetheless (and, more often than not, as the
internal enemy.) This antagonism towards the African-American is summed up in the
question How does it feel to be a problem?178 In an almost lyrical expression of his
paradoxical consciousness of his lack of self-consciousness, Du Bois too (in the first
chapter of The Souls of Black Folk) asks us to not only consider what this entails for the
African-American179 but also for American society as a whole. 180 By pointing us towards
the phenomenon of double consciousness of the assimilated Black, Maldonado-Torres
40

has provided us with the key to dissolving the paradox expressed by Fanon when
elaborating his lived everyday experience. Yet, this also moves Fanon into a head-on
confrontation with Carl Schmitt.
In examining Black self- hatred in Martinique in chapter six of Black Skin, White
Masks, Fanon brings to the fore what is at stake both in Black self- hatred and white
racism(in the French colonial setting.) Noting that the Black middle-class child in
Martinique was socialized in the same manner as a white child in mainland France,
Fanon goes on to describe that one of the means of this consisted of comic strips and
adventure stories male children read at around the age of eight or so. In these, Fanon
shows that the Wolf, the Devil, the Evil Spirit, the Bad Man [and] the Savage were
always symbolized by Negroes and Indians. This point about the negative
characterization (of the Black especially), however, was key: for, as his quote from
Gershon Legman makes clear, such characterization served two vital purposes in
maintaining social cohesion.
The first was to reinforce a denial of guilt for any past (and continuing) wrongs
committed by the society. Although Freud had earlier shown that such denial was an
exercise in futility and self-deception which was ultimately doomed to failure (as the
guilty party would unconsciously seek out punishment.) 181 However, such denial still
became one of the myths by which the governing fiction of whiteness constituted
itself 182 (especially in societies founded upon the genocide of an autocthonous
population.) 183 The second purpose of such negative characterization of Blacks was that
of cathartically redirecting the frustrations and aggressive tendencies of members of the
society away from the society itself. 184 If there was to be social cohesion, there needed to
41

be some means by which (for example) to redirect a laid-off workers anger away from
his superiors or even to redirect the anger of rebellious teenagers away from their parents
(to use two very clichd examples.) The solution, then, would invariably be found in the
creation of a convenient enemy whom all of society would see itself at war with. In
terms of a colonialist society, this was often accomplished by transforming the victim of
the societys outrages into a menacing outsider. 185 In Fanons case, this meant
transforming the Black into the enemy precisely in the sense of the Latin term hostis
in Schmitts Concept of the Political (literally, the enemy of ones own people.) 186
Thus, when the assimilated Black in Martinique socialized in the same manner as a
white Frenchman discovered that the term Negro applied to him (along with the
African), he was thrown into a psychological crisis (as he was saw himself, at once, as
the enemy to himself.) This resulted in his action being directed entirely towards the
(white) Other and his worth being determined by the other. 187 This search for
recognition, however, would continually be frustrated as white society would
aggressively refuse him (or her) while actively seeking his or her or nonexistence.
Up to chapter four, then, the Hegelian metaphor deployed by Fanon was quite apt:
desires, in fact, are determined by the naming of their object, objects of desire are
pursued by desiring beings seeking to fill their own emptiness with content from the
other, and beings often compete for the desired object. Indeed, this pursuit of the desired
object by an essentially empty being is a particularly apt characterization of the grossly
superficial views of romance had by Mayotte Capcia 188 and the Jean Veneuse189
character of author Ren Maran described in the second and third chapters of Black Skin,
White Masks. However, in refuting Mannonis idea of the dependency complex, Fanon
42

made clear the reality of competition between desiring beings (while at the same time
questioning the idea of the slaves voluntary surrender which is so essential to Hegel.)
Thus in chapter four we begin to notice cracks in Fanons Hegelianism. In chapter five,
however, is when the Hegelian metaphor becomes completely unworkable.
The use of Hegelian master/slave dialect as a metaphor for racism falls apart
not only because of the fact that the master never recognizes (but merely uses) the
slave in Hegel but, more importantly, because the roles played by the white and Black
in early 20th century French society did not (respectively) correspond to that of the
master and slave in Hegel. This is because of the fact that the Black actually plays
the role of the internal enemy in terms of racism. 190 As Fanons initial analysis of
childrens literature has shown, the white society he describes was one plagued with guilt
and latent aggression. Not being at peace with itself, the need for an enemy becomes
all-too-apparent if the society is not to literally collapse in upon itself and later portions
of the sixth chapter show exactly how deep this disquiet ran. Thus, if the society is as
Fanon characterized literally a collection of guilt-ridden, passive-aggressive neurotics
who were on the brink of tearing each other apart reading Fanon with (but not
necessarily through) Carl Schmitt and stating that (for the white society Fanon described)
the Black served as the internal enemy is not only plausible but it also explains the
particular viciousness of the racism Fanon experienced as well as his experience of a
variety of double consciousness not too far removed from what Du Bois described in
1903.
However, if the Black indeed serves as the internal enemy this entirely rules out
any notion of a dialectical master/slave relationship between the Black and the white.
43

This is precisely because, whereas with Hegel killing the other defeats the purpose of
mastery, with Carl Schmitt the enemy is precisely the one who must be exterminated
and he even says as much, stating that a weak people which no longer possesses the
energy or the will to maintain itself in the sphere of politics will disappear.191 This
being the case, emphasis turns from the master/slave dialectic which comes into
existence after the life and death struggle back to that initial struggle itself. As Fanon
indicates in the section on The Negro and Hegel in chapter 7, that situation was
characterized by the mutual recognition of desiring beings 192 (yet undoubtedly one
which was antagonistic, as it immediately precedes the life and death struggle.) 193 This
antagonistic situation was clearly not Fanons ideal since as he has shown in both The
North African Syndrome and Black Skin, White Masks a society so constituted in its
antagonisms makes possible the conditions leading to the psychological distress of its
members. Fanon thus finds it necessary, at the end of Black Skin, White Masks, for
society to at least begin rethinking its relationship towards the other 194 for only
through a real engagement with the other could the psychological alienation (of both
Black and white) be escaped. This question of how the recognition of the other could be
accomplished without antagonism (and how a community, based on such nondominant,
might be constituted) would be posed time and again in the studies Fanon conducted
during his directorship at psychiatric hospitals in Blida, Algeria and Tunis.

44

Chapter 4
A Critical Introduction to Fanons Clinical Studies
As it turns out, Fanons early attempt at examining the psychological effects of a
racist society upon the individual was rejected by his examining committee as being
overly subjective and instead he chose a more expedient topic: a quantitatively-based
case-study of a person suffering from Freidreichs ataxia who also suffered from
delusions of demonic possession. Demonstrating his competency in the psychiatric
field, Fanon first of all reaffirmed the canonical distinctions between neurology and
psychiatry (which had been in place since 1882.) 195 Further, Fanon chose a new frame of
reference: Lvy-Bruhls notion of primitive mentality.196 Having done his part to
illustrate the primitiveness and degeneracy of this (undoubtedly French and most
probably white) sufferer of Freidreichs ataxia, Fanon met with his examining
committees grudging approval and was passed. 197 Thus Fanon began his residency at the
St-Alban Hospital (which enjoyed a reputation for being a haven for fleeing resistance
fighters and undesirables, as well as radical therapists during the Second World War.) 198
There he would intern under Franois Tosquelles, whose doctrines (and especially t he
thorough manner in which they were applied) would provide a basis from which he
would rethink his dialectic relationship to his patients during his clinical practice. As
Tosquelles was a vital influence Fanons view of psychiatric practice, it is fitting that we
should discuss him (and his doctrines) before beginning our discussion of Fanons studies
themselves.
45

Fanon and Tosquelles

Francesc Tosquelles Llaurad, was born in Reus, Tarragona, Catalunya in 1912.
Having studied under leading Catalan psychiatrist (and phenomenologist) Emile Mira i
Lopez199 as well as psychoanalysts Sandor Eiminder and August Aichorn, Tosquelles
developed an early interest in the relation between Marxism and psychoanalysis. 200
However, by 1934, Tosquelles had begun to find psychoanalytic methods unsuited to
institutional practice and thus, after being introduced to the work of Gestalt
psychologists, began experimenting with a different approach: the restructuring of the
hospital itself as a therapeutic community.201 These experiments would develop into
what Tosquelles would term institutional psychotherapy during the 1940s (and later
sociotherapy.)
Sociotherapy conceived of mental illness as revolving entirely around the
traumatized human and their ability to function socially. Its approach sought to both
reinforce habits that encouraged socialization and to address the underlying trauma. Thus
although madness was indeed forbidden within the sociotherapeutic milieu, this
milieu was one that was purposefully structured to allow for social engagement (on the
part of the patient) as well as the taking on of greater social responsibilities as well,
Tosquelles also made use of group therapies and even individual counseling in order to
address the underlying issues which caused the patient to become asocial. For
Tosquelles, then, madness was not the inherent trait possessed by the mentally ill (who,
in turn, were seen as the embodiment of their disease.) Instead, madness was
reconceived as an ineffective coping mechanism with which the patient dealt with intense
traumas and/or burdensome social expectations. Sociotherapy thus served to break such
46

habits while also encouraging the patient to take an active role in addressing their
underlying issues. As such, sociotherapy represented almost a clean break with the past
in that patients were now seen as agents in their own recovery (with physicians serving
only to aid such efforts.) Having fled Spain in 1939 (being a former head of psychiatric
services for the Spanish Republican Army 202 ), Tosquelles imported this new form of
therapy with him and began implementing it after obtaining a second (French) medical
degree.
Although stormy at first, Fanons relationship with Tosquelles soon became one
founded upon shared political and professional commitments (even if slightly differing in
philosophical orientation.) Thus, with Tosquelles guidance, Fanon was able to obtain the
training needed in order to sit for the mdicat des hpitaux psychiatriques. 203 As a
qualification that would enable him to serve as a mdecin chef de service (that is, clinical
director) 204 in any state-run hospital within Frances territory, the mdicat des hpitaux
psychiatriques tested the physicians general knowledge of medical practice as well as
specialized knowledge of clinical psychiatry. This was important because, as mdecin
chef, Fanons duties would include conferring with other physicians regarding the course
of action to be taken with patients as well as training interns in psychiatric practice.
Although he indeed passed and was able begin a clinical practice in any state-run
psychiatric facility, his unexceptional ranking on that exam (13 out of 23), 205 led to his
being passed over when his application to work in Senegal was considered. 206 In the
interim, Fanon took a temporary position in the picturesque countryside of Normandy (at
Pontorson) while weighing his options. This turned out to be an unmitigated disaster and
thus (in late 1953) he accepted an offer to work at the Blida-Joinville Psychiatric Hospital
47

in Blida, Algeria (which was then the only psychiatric hospital governed by the Law of
1838 in French Algeria.) The remainder of this chapter will discuss Fanons clinical
studies in terms of the constituting of a therapeutic community. The first group will
discuss Fanons rationale in pursuing such; the second will speak of the problems
involved in seeking a non-adversarial means of addressing the other on their own terms;
and finally the third discuss the problems posed when community itself come in conflict
with its members. Thus we will begin with Fanons rationale for seeking to reorient the
psychiatric hospital as a therapeutic community.
The Rationale
In The Maghribi Muslim Attitude Towards Madness (1956), Fanon and coauthor Franois Sanchez argue (on the conceptual level) that the politicized practice of
psychiatry entails the holding of logically inconsistent ideas concerning mental illness. 207
Simply stated, how can the mentally ill be considered the enemy and yet (at the very
same time) also be said to hold no responsibility for their actions? Even in terms of
Schmitt, the political entity must at the very least be a decisive entity208
therefore, on the face of it, it would seem that any political distinction wo uld require
some form of agency (or at least intentionality) on the part of domestic enemy 209 as
with the public itself (otherwise there could be no political situation to begin with.)
In the case of the mentally ill, however, one was faced with the prospect of
enemies who is said to have neither agency nor intentionality in any ordinary sense (as
mental illness would preclude such at least with regard to abnormal behaviors.) Hence,
the contradiction involved in classifying of the mentally ill as the enemy required that
the agency and intentionality denied the mentally ill by way of their illness nonetheless
48

be affirmed by some other means. Fanon illustrates the performative contradictions

involved in this not only by discussing patient abuse in the clinical setting (such as
punitive measures taken against the patient for outbursts, etc.) but also by giving the
example of a parent embittered by insults leveled at her by her son during a psychotic
episode. 210 In an interesting rhetorical move, however, Fanon and his co-author contrast
the politicized notion of psychiatry (and its notion of the patient as enemy) with one
that was far more logically consistent: the belief in jinns held in some rural villages in the
North Africa.
Although at first glance it might seem as though Fanon was being facetious, the
point he makes is actually important: possession by jinns (in the cultures that believed in
them) entailed a totalizing lack of agency and intentionality on the part of the possessed
(insofar as abnormal behaviors were concerned.) As the possessed were in no way at
fault for their abnormal behaviors, the response entailed was not one of excluding them
from the community but of using the communitys resources to free them from the
malevolent entity that had taken them hostage. 211 Once the jinn was exorcised (or, in
more contemporary terms, once the illness was successfully treated), there was no
question of the place in society of the formerly possessed in some cases, even
patients undergoing treatment were permitted to enter into marriage contracts (on the
condition of continuing their treatment.) That is to say, mental illness did not carry the
stigma of degeneracy in these societies 212 quite in contrast to the practice of modern
and scientific Western nations of mental illness (even during Fanons own time.) 213
Although this traditional view of the ill as possessed differed significantly from
Tosquelles (in that Tosquelles saw the mentally ill patient as a traumatized person who
49

had developed ineffective coping mechanism), the point was that (similar to Tosquelles
and other psychiatrists of his orientation) the views of this particular society of the
Western Sahara region (that is, of the Maghrib) did not approach the mentally ill other
from a position of antagonism (which made all the difference in how they dealt with
them.)
Hence, the antagonistic notion of psychiatry also entailed an abusive relationship
towards the patient whereby the patient would inevitably remain institutiona lized often
in worse shape, psychologically, than when initially hospitalized. As an e xample of this,
Fanon (in The Phenomenon of Agitation in the Psychiatric Milieu, published 1957) 214
described the case of violent patients who were placed under restra int for excessive
amounts of time after initial violent episodes. Deprived of interaction with other patients
(and their lived environment), these patients soon began to lose touch with reality. 215
Having entered an hallucinatory state, the patient became more unstable and prone to
violent outbursts (hence, less able to rejoin social life within the psychiatric hospital) than
they were when initially restrained. In short, the psychiatric hospital (where the patient
was treated as the enemy) became a self-perpetuating institution that reproduced the
madness that made its existence necessary. 216
In reforming such an institution, however, the problem was not merely one of
opening doors, getting rid of leather straps and straitjackets, 217 or even of replacing the
former means of contention with the chemical camisole 218 of Thorazine: a hospital
which resorted to such punitive measures such as routinely drugging difficult patients
was already a failed hospital. 219 An effective, well-organized, hospital (by contrast)
would seek engagement between the physician and patient (allowing both to better
50

understand their patients condition.) With such dialogue in place, adjusting to each
situation as it occurred, the patient would come to understand their illness and work
(with the aid of the physician) to better manage it. Thus, opposed to the manufactured
necessity of the politicized psychiatric hospital (with its antagonistic relationship between
patient and medical professionals), the well-organized psychiatric hospital would be
characterized by its engineered obsolescence (namelydeclining or residual [patient]
rolls.) 220 Fanons example of such a hospital was thus the clinic he directed between
1958 and 1960: the Tunis Center for Day-Neuropsychiatry.
The Tunis Center for Day-Neuropsychiatry (abbreviated CNPJ in French) was a
psychiatric day- hospital connected with the Charles-Nicolle Hospital in Tunis. With dayhospitalization, the problems of incorporating the patient into hospital life or figuring out
which model of society suited the patient (problems which plagued the institutionallybased Tosquellian model) were not really an issue: the patients social milieu was
precisely the environment they returned to after the group therapy sessions and
individualized treatments administered at the clinic (or so Fanon assumed.) 221 Upon
returning to their homes, such patients would resume their daily routines (interrupted
only by their therapy each day.) 222 Social environments being individual to each patient,
coercion as to social norms would be kept at a bare minimum. As well, given that the
patient was seen as a community member, certain clinical practices were entailed as well.
For instance, the hospital staff would not harbor prejudices towards the patient
that rendered him (or her) a madman or lunatic in their eyes and even when
presented with graphically violent dream materials during their daily interview they
nonetheless suspend judgment and diligently record the data presented (drawing up
51

detailed reports to be interpreted by the physician in deciding the course of treatment.) 223
Such professionalism not only extended to giving each patient a physical exam before
treatment (something pioneered by Tosquelles in Republican Spain during the 1930s) 224
but also to clinical procedures an example of this being the use of insulin therapy at the
CNPJ.
Insulin therapy was a dangerous procedure (now rightly considered barbaric)
which was used in treating schizophrenia before psychotropic medication became widely
available. It involved placing the patient into insulin shock (or even an insulin coma)
each day for an average of 40 to 60 insulin shocks/comas during the entire course of
treatment. Although it was marginally effective in treating schizophrenia, the patient
would usually be subject to seizures, uncontrolled salivation, cerebral edema, and other
internal organ damage during treatment. After treatment, side effects included relapses
into shock (or coma) as well as massive weight gain (since the body, in effect, would be
starved during the treatment.)
At the CNPJ, this procedure was handled with several safeguards: these included
close supervision of the patient during and after treatment, instructions given to the
patient and their caregivers as to how to deal with the onset of insulin shock, 225 and direct
access (for the patients caregivers) the physician after hours. 226 Further, the number of
treatments administered to insulin therapy patients at the CNPJ was well below the
average of most Western psychiatric facilities (only 35 to 45 induced insulin shocks or
comas, 227 as opposed to the norm of 40 to 60.) As well, patients receiving this form of
therapy were encouraged to take part in the group activities within the clinic after the
procedure, possibly as a corrective for such side-effects as memory loss that often
52

followed from insulin therapy (although under supervision, in case of the aforementioned
medical emergencies.) Finally, treatment would even be suspended during occasions
such as the month of Ramadan (when, given the fasting already taking place, its
employment would become especially problematic.) 228 The goal of the CNPJ, then, was
not the formulaic employment of procedures (for the sake of clinical rigor) but the overall
health of the patient. 229 This view of treatment also applied to the use of
electroconvulsive shock therapy which, according to Fanon, was only administered as a
treatment of last resort and then only to a maximum of three sessions during the entire
course of treatment (with care being taken that the patient was not injured.) 230
At the CNPJ, then, the physicians relationship to the patients caregivers,
associates, and so forth, was one of cooperation (as opposed to exclusion.) Whereas
physicians adhering to earlier models of psychiatric practice had counseled against
allowing any family involvement in treatment whatsoever, community involvement was
integral to the CNPJs work. Although such involvement was clear in the example of
insulin therapy, it also extended to encouraging the patients caregivers to take an active
interest in the recovery of the patient. This, in turn, ensured that a safety- net would
already be in place in the patients community once the patient recovered. 231 Such efforts
were further aided by the extensive statistics kept by the CNPJ regarding the
socioeconomic status of the patient (as well as their previous history of trauma and
such.) 232 These would not only aid the physician in better understanding the nature of the
patients illnesses but also in their efforts to improve the provision of psychiatric services
in general (for instance, the provision of such for Algerian refugees during final years of
the Algerian War.) 233 For Fanon, then, the depoliticized nature of the CNPJ (wherein the
53

clinic and the patient were integral to the social environment) not only entailed the
inclusion of the mentally ill in their communities but also the involvement of the
physician in constructing and/or reinforcing that community as well. 234 As for the rates
of recovery, Fanon was quick to point out how the average time in treatment at the CNPJ
had declined from 53 days in May of 1958 235 to15 days in November of 1959 236
indicating the well-organized nature of the CNPJ. However, the question of how
community was to be constituted would be addressed in a second group of studies.
Failure to Identify the Social
The question of community was posed quite explicitly in the articles
Sociotherapy on a Ward for Muslim Men (1954) 237 and The T. A. T. amongst Muslim
Women: Sociology of Perception and Imagination (1956), 238 which describe successive
failed attempts by Fanon (and respective co-authors Jacques Azoulay and Charles
Geronimi) at integrating North African patients into the social activities of the Blida
Psychiatric Hospital. The first detailed an attempt to implement Tosquellian sociotherapy,
while the second described a later attempt at administering the Thematic Apperception
Test. In seeking to implement these two procedures both of which relied on the
patients sense of the social Fanon and his colleagues were presented with a choice of
two approaches to identifying the forms of sociality specific to the North African social
sensibility. They could either conduct a detailed investigation into how North African
patients conceived of and constructed their own forms of sociality or else they could take
up a politics of assimilation239 which assumed that dominant conceptions of the social
were appropriate to all cases.

54

The term politics of assimilation, for Fanon, specifically entailed the model of
colonization whereby the colonized were supposedly included into the colonial society
insofar as they had adopted the colonizing culture. Although such lent an air of
respectability to colonization, time and again even as early as 1936 (with the
publication of Ralph Bunches World View of Race) studies have shown that such
inclusion was at best illusory. Even at the ideological level, philosophers such as
Lewis Gordon have shown that the conceptual framework of such assimila tionism was
just as steeped in white supremacy as the better known variety of racism present in
Anglo-American domains whiteness, in both cases, functioned as an unobtainable
non-racial status at the top of the chain of being. 240 Within psychiatry, such an
assimilationist stance entailed the perception that any behavior outside of French cultural
norms was pathological. Fanons attempted rejection of the politics of assimilation in
both Sociotherapy and The T. A. T. amongst Muslim Women, however, also had its
consequences as well.
For instance, although resistance was present in the case of the men in
Sociotherapy from their abruptly exiting of Fanons organizational meetings 241 to
their leaving a screening of a Jean Cocteau film en masse 242 the hidden transcripts
deployed by the women (regarding the Thematic Apperception Test) were unmistakable.
In seeking to determine why the women on his ward failed this test (known by its English
acronym T. A. T. in this article), Fanon soon found the test itself on trial as patients
routinely pointed out that the situations depicted on the cards used by the test (into which
they were to read meaning) were anything but universal. One woman, using a great
deal of sarcasm, even explicitly dismissed the test as nonsense. 243 Recognizing his
55

problem in the failure to identify the properly North African forms of the social (at least
for these particular patients), Fanon however found himself seeking to articulate what he
thought the components of that were. In the case of the men, although he had earlier (and
quite forcefully) condemned racism against North Africans in French psychiatric
facilities, in Algeria he found himself dismissing the problem of a properly Muslim
sociality at Blida as merely one of how to better transition a rural peasantry (with its
quaintly archaic customs) into modernity. 244 Although such characterization was not as
blatantly racist as speaking to North Africans as if they were children, it nevertheless
contained a strong element of the discourse that rendered the North African anvolu.
In the second study, Fanon entirely dismisses one womans claim that aspects of
the T. A. T. may have violated her interpretation of Islam (which was a decidedly
literalist interpretation.) 245 Instead, he sought to articulate her (and other womens)
refusals to participate in the T. A. T. in terms of resistance to the imposition of a foreign
imaginative schema. In this latter case, however, the reasons for his maintaining this
stance were not motivated by a lack of understanding but rather by a desire not perform
the same kind of reduction with regard to the North African Muslim as he had
experienced in France. Just as he was more than the sum total of tom-toms, slaveships, and Sho good eatin Banania advertisements, 246 so too the North African
Muslim was to be seen as more than a sum total of hadiths, fatwas, and Quranic
injunctions. This was also vital for his clinical practice since (at the level of practice)
such reductionism would tell the physician absolutely nothing about the social life of the
North Africans: it might very well be true that Islam is a way o f life, that it is
theocratic, so on and so forth, 247 but from that one learned nothing about, e.g., why the
56

North African men on Fanons ward at Blida did not have a team ethic which could be
accessed by means of sports activities. That knowledge could only be gained by learning
the specific and relevant facts about the patients life: in terms of the North African men,
the lack of team ethic was found to be the direct result of the fact that in their pre-teen
years these men actually worked (while others were playing in school.) 248 Thus, in terms
of seeking not to replicate stereotypical views of the North African and (just as
importantly) in terms of rigorous clinical practice, there may have been more than a little
justification for Fanon especially as a non-Arabic speaking native of Martinique who
had seen firsthand the discrimination against the North African in France to view
religiously-based explanations of North African behavior with suspicion. However, the
result was that he nevertheless ended up substituting his own construct of the womens
resistance in place of their own (the very thing he criticized the T. A. T. for.) 249
These exchanges between Fanon and the North African patients, then, point out
two problems posed by seeking to build community with those whose forms of sociality
one is unfamiliar with: first, by what criteria does one properly identify the social (and
hence, community) and, secondly, to what extent is this identification compromised by
ones own preexisting conceptions of the social? At stake is whether a community
can be identified or engaged with on its own terms or not. Fanons atte mpts at
identifying a properly North African sociality at Blida thus illustrate not so much Fanons
own failing as much as the fact that rejecting the politics of assimilation is much more
difficult than many of us would like to admit. Instead of merely pointing out serious
perfomative contradictions on Fanons part, these attempts point to the real complex
communication (to borrow a term from Mara Lugones) which must take place when
57

building community (or even coalition) with others whose ways of being one might find
unfamiliar. The fact that Fanon progressed in later years in his understanding of North
African cultures can thus been seen as a part of the conscious effort at such complex
communication on his part. However, another problem arises during the course of
Fanons clinical practice: that of the vicious community.
Vicious Communities
Conduct of Confession in North Africa (1955), Current Aspects of Psychiatric
Care in North Africa (1955), and The Encounter of Society and Psychiatry (1959) all
examine the difficulties (and indeed, impossibility) of reintegrating the patient into a
community from which they are alienated from the very beginning. Such vicious
communities not only provide the conditions whereby the destructive or self-destructive
behaviors are made possible but also make those conditions necessary. If the idea behind
removing antagonistic relations towards the patient within psychiatric practice rests on
the assumption that patients should reintegrate into society, what happens if that society
is every bit as abusive towards the patient as anything in the asylum? Fanon thus
addresses this issue beginning in the most obvious of places: colonial Algeria.
In The Conduct of Confession in North Africa, 250 the question is posed simply
enough: if confession is the means whereby the criminal regains his place in the public
sphere, what does it mean for the accused to recant? 251 The cases Fanon and his coauthor recount in this piece specifically involve North Africans on trial for non-capital
offenses in colonial Algeria. In such cases, after having signed a confession and admitted
to a relatively minor offense, the accused would them recant it entirely claiming that the
confession was obtained under duress. 252 As the confession was precisely the means by
58

which the psychiatrist would gauge the accuseds psychological state, a recantation
presented the psychiatrist with serious problems in determining the mental state of the
accused (the very thing denied the psychiatric expert had sought to determine in the first
place.) 253
One means of approaching this dilemma would be to say that there was no truth
to begin with and that the accused didnt confess because s/he was a pathological liar
however, Fanon and co-author dismiss this immediately as a non-answer that tells one
nothing (either about the act or the motivations behind the recanted confession.) 254
Instead they propose another way of addressing the question: if confession serves as a
means of reintegration into community life, such means within the colonial context such
function was already compromised one cannot be reintegrated into a society that had
rejected one from the very beginning. 255 Recanting, therefore (and accepting the
consequences), was a means of resistance on the part of the colonized who being part of
a separate, subordinate, part of society refused to legitimate the dominant society. 256
Although they were quite blind to the reality of torture and coercion in the
Algerian colonial society at his point (and dismissed the North Africans own account of
torture), Fanon and his co-author noticed that colonial society implied the existence of
two (or more) competing senses of community precisely the political situation of the
society and its internal enemies (this time, Algerian) conveyed by Schmitts account. 257
In terms of their confessional conduct of the Algerian, then we find that colonial
society again had not only created an enemy but also a different sense of self on the
part of the Algerian. However, the question of the impossibility of reintegrating the
colonized into the colonial sphere was also put at the very concrete level in Current
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Aspects of Psychiatric Care in North Africa (published the same year as the previous
study.)
Using the occasion of the Orlansville Earthquake of 1954 (and its damage to the
Blida Psychiatric Hospitals two Annexes) as their backdrop, in Current Aspects258 the
clinical directors at Blida (including Fanon) write what amounts to an open letter
(published in the medical journal Information Psychiatrique, but clearly addressed to the
colonial government in Algeria) whereby they discuss the problems associated with
admission, treatment, and discharge of psychiatric patients at the Blida Psychiatric
Hospital. Although there were five authors to this article (most of whom had opposing
viewpoints regarding psychiatric practice), 259 all were agreed to the fact that the
psychiatric infrastructure in French Algeria (by 1955) was dilapidated. The problems
arising from such applied especially to the case of North Africans interned at Blida.
Admission to Blida, for North Africans, generally reflected their status as being
outsiders within colonial society. 260 The vast majority of patients at Blida were North
Africans who were placed there by order of the colonial government (and almost always
when their illnesses had reached an advanced stage.) Yet, because placement was done
on a space-available basis, such ordered placements were not automatic and many were
listed as free voluntary placements to be placed on a waiting list while the hospital
bureaucracy examined their financial resources and such (or, actually, waited for space to
become available while using bureaucratic procedures as a cover.) The process of free
voluntary placement often took years, by which time several things would happen:
spaces would open up and such patients would be admitted as ordered placements (as
was intended in the first place); the illness would reach a stage where a cure was no
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longer feasible; caregivers who no longer had the resources (financial, emotional, and
otherwise) would abuse the patient or simply abandon them at the gates of the hospital; or
else the initial illness would have passed on its own by the time the hospital was ready to
admit the patient.
Once hospitalized, things were no better. Whatever therapeutic value might have
been derived from hospitalization was rendered ineffective not only by the previous
neglect but also by the massive overcrowding at Blida. 261 With even former washrooms
and dining halls converted into dormitories for patients, Blida in 1955 could no longer
effectively treat patients instead it had become a warehouse. Although these conditions
were somewhat relieved by the addition of more doctors a nd a better trained staff, they
were still not conducive to patients rejoining society in any sense. Most revealing of the
impossibilities of reintegrating the colonized into colonial society, however, were the rare
cases of discharge from Blida.
Although release became more frequent with the addition of more doctors and the
implementation of modern clinical procedures, it was still widely assumed that once
released the patient would take their place in a French colonial setting. However, there
were neither dispensaries (for medication, etc.), nor counseling services, nor agencies to
aid the released patients in finding work, nor anyone keeping track as to their
whereabouts. 262 Patients were thus left to fend for themselves and would effectively
disappear from view until a relapse eventually brought them back to the hospital (at
which point they would repeat the arduous, bureaucratic process associated with
admission.)

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In other cases, even when a crisis had passed, the patient would not be released
because they literally had no place to go. In the case of Algeria, these would often be
women divorced under a particularly retrograde interpretation of Islamic Law which
allowed for divorce merely by the husband pronouncing divorce from his wife three
times (without witnesses even.) A woman divorced in such a manner (and probably
unaware it had occurred, especially if mentally ill) would thus have no family to return
to and would have to wait (in the Hospital) as the bureaucracy searched out her next of
kin (often with the aid of other bureaucrats.) 263 Especially in the case of such
divorced women, one can see how the patients own community was complicit with
their overall exclusion from society.
As it stands, then, this third group of studies already presents a bleak picture of
the prospects of the colonized being reintegrated into colonial society because, first of all,
there was the question of which colonial society? In the dominant colonial society,
such reintegration would not occur because there was no initial integration to begin with.
Either the colonized would assimilate or fade into the background 264 (as the enemy
living on its knees in the Casbah or some other ghettoized space. ) 265 Even as far as
assimilation goes, Fanon would later note that this was not a real option either. Given
that the dominant society would not tolerate the prospect of the enemy in their midst,
the assimilated Algerian especially if a woman was often seen as being either
presumptuous 266 or else as simply a prostitute. 267 Add to this situation the stigma which
already placed the mentally ill outside of society and you find the colonized North
African, formerly excluded within Blidas walls, also excluded outside (with cultural
conservatism within their community making this exclusion absolute.)
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As Current Aspects indicates, colonial society was based on containment and

neglect at all levels: the containment and neglect of the Algerians outside of the hospital
was precisely what led to their containment within it (and further neglect when they were
released.) Given such conditions, the therapeutic community envisioned by early
advocates of deinstitutionalization like Tosquelles (whereby a patient could successfully
reintegrate into society) was not just difficult but impossible within a colonial setting.
Hence Fanon would later state that the colonial setting was a fertile purveyor for
psychiatric hospitals.268 The final study in this group (The Encounter of Society and
Psychiatry, a lecture series presented at the University of Tunis in late-1959 and early
1960), thus find Fanon discussing this theme of vicious communities in their more
generalized occurrence.
Drawing on the work of English-speaking child psychiatrists Margaret Mahler
and Donald Winnicott, 269 Fanon takes as his point of departure (for discussion on the
psychological effects of racism) an inversion of Lacans mirror stage. Instead of
conceiving the early childhood personality as fragmented, Fanon saw it as a time when
the child perceived itself as part of a continuous, all- inclusive, social (and even physical)
environment. 270 Hence, as the childs personality was already integrated with its
environment at all levels (in the Fanonian account), the recognition of itself as an
individual self (during the mirror-stage) constituted a separation for the child from its
earlier form of existence. However, this had consequences.
For example, if the young child was in fact unable to distinguish itself from the
environment, what would happen if it was born into an environment characterized by
spousal abuse or where the father doubted its paternity (and thus harbored resentment or
63

outright hatred towards it)? Succinctly, what happens if a child is born into an
environment characterized by antagonism? The answer was simple: such attitudes would
become completely internalized by the time the child was able to distinguish its self in
the mirror. Thus Fanon notes that, as early as a year or so, children would begin to
display the tell-tale habits and behaviors that would follow them throughout life
(including phobic behaviors and such.) 271 In the case of anti-black racism in the United
States, the ramifications of such were quite obvious and essentially Fanon characterizes
the problem in the manner in which he described of the reintegration of the colonized
within a colonial space: as with the Algerians, the life of Blacks in America was
characterized by a state of containment and neglect and this entailed a wide range of
psychological aftereffects for African-Americans. These included aggression directed
towards members of the group (as outwardly directed aggression indeed entailed severe
consequences at the level of concrete life 272 ), overcompensation in the Adlerian
sense, and a desire for revenge. 273
Although these characterizations of the African-Americans psychology have
become clich during the fifty years since Fanons death, Fanon goes on to point out that
there could be nothing resembling trust or cooperation between the races as long as
Blacks remained dominated. This again repeats what he said in Conduct of Confession
regarding the Algerians (as well as the statements previously made in Black Skin, White
Masks.) For Fanon, then, at issue was the antagonistic view society had of Blacks (who
in America, as in France, were viewed as the enemy) Although some would brush this
aside and glibly remark (as one of Fanons interlocutors in Black Skin, White Masks) that
Blacks make themselves inferior, such is nothing more than an attempt to wish away a
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political conflict by denying that it existed: and as Schmitt noted in the 1930s, pretending
a political conflict is something other than what it is does not change its character. 274
However, the notion of vicious communities was not merely confined to abusive
households nor were they even of an overtly racialized character. Take, for example,
workplace surveillance.
Having transitioned from the qualitative control of the craftsman to the
quantitative control of the factory owner, work had become a question of extracting as
much labor out of the worker as possible. 275 Time, then, was something of which every
idle moment had to be thoroughly accounted for. In order not to be cheated out of
labor by lax or dishonest workers, employers (by the 1950s) increasingly began installing
surveillance cameras (euphemistically termed anti-theft devices.) For the worker, these
devices took on the sinister character of an ever-watchful Grandpa or shopkeeper
following their every move through the store. 276 The effects of such surveillance were
described by Fanon with reference to Louis Le Guillants well-known studies on Parisian
telephone operators.
Profiled even in Time Magazine, Guillants studies of these telephone operators
(all of whom were notoriously rude women) revealed that more than a few of them
were in fact psychologically disturbed. Constant surveillance and the need to account for
time, to keep telephone lines open, to place everything into mentally compartmentalized
files, had led the operators (subject to nervous tension) to become obsessive to the point
of having violent outbursts at customers and eventually believe their mind was being
controlled by external forces. 277 Eventually the operator would be found wandering
aimlessly into oncoming traffic. 278 However, even when psychoses and eventual suicides
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did not occur, such switchboards controlled by surveillance, were characterized by the
frequency of accidents by workers traveling to work as opposed to from work (even
though the latter workers were clearly more exhausted), insomnia, the eventual loss of
reflex control, and nightmares (most of which involved recurring themes of exclusion.) 279
Related to this account was that of colonial labor.
As with capitalists in highly industrialized countries, the colonial settler had
arrived in the colony for the sole purpose of extracting as much profit as possible from
the native.280 To this end, according to Fanon, the settler (like the industrial capitalist)
did not really see the native as human but merely as a resource to be exploited.
However, even as the settler sought to extract the most profit from the colony as possible,
the colonized sought the opposite and thus tried to make profit as difficult for the settler
as possible. 281 Forced labor thus became a characteristic of the colonial labor relation (as
the worker would resist the settler precisely by working only as much as necessary.) In
describing surveillance in the industrialized world, however, Fanon notes that such
resistance was also present within the capitalist labor relation: for instance, workers
would avoid being penalized for lateness by calling in sick. 282
With The Encounter of Society and Psychiatry, then, Fanon asks us to consider
the problems posed by vicious communities (ranging from family groupings to the
workforce.) Discussing various social phenomena from abusive home environments to
the lived effects of dispassionate capitalism these lectures ask us to seriously think the
extent to which even the patients own communities (into which psychiatrists were asked
to reintegrate them) were themselves characterized by destructively political conflicts.

66

As Fanon hints at in the beginning of these lectures, considering such things ultimately
brings into question the very possibility of community.

67

Conclusion
In closing let us first say a few things about the third psychiatric revolution (as
seen by one of its participants, Flix Guattari.) Detailing Franco Basaglias career in a
review of Institution in Negation, Flix Guattari begins by portraying the optimism which
accompanied the third psychiatric revolution (beginning in 1961.) Whereas the first
and second were attributed respectively to Pinels application of the Montpellier
vitalisms holistic view of the patient to the psychiatric setting and Freuds ideas of the
unconscious and the social character of neuroses (respectively), the third psychiatric
revolution promised a violent refusal of all scientific pseudoneutrality which would
free psychiatry from the mandate of the cure and of surveillance. 283 Instead, psychiatry
would seek to form a therapeutic community between physicians and patients.
However, after many efforts towards a more community-centered approach,
psychiatrists found that their more enlightened techniques only furthered the aims of
social control.284 Bitter and disillusioned, they soon resigned themselves to the fact
that the third psychiatric revolution was doomed to become merely a series of
didactic and therapeutic engagements which nonetheless eventually retreated into the
domain of institutional interests.285
Negating the institution and designating mental illness a myth only served to
further repress mental illness by bringing madness itself into question. 286 The norm
would thus be upheld at any price with any dissent from it being referred to as a social
condition derived from the pathology of households, cultures, and such. In short, such a
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psychiatric practice would only serve to reinforce a politics of assimiliationism more

thorough and effectively than the police ... with physicians (in Basaglias words)
merely administering medications to the supposedly ill to calm their own anxiety in
the face of persons whom they did not know how to enter into contact nor find a
common language with. 287 In describing the demise of the third psychiatric revolutions
promise of deinstitutionalization, Guattari thus illustrates precisely what was and is at
stake (not only in the treatment of the mentally ill but also in any attempt at embracing
the politics of nondominant difference): namely, whether or not an antagonistic view of
the other is unavoidable. In terms of this, we may contrast Fanons views of engaging the
other (as expressed in his clinical studies) with that of both Hegel and Carl Schmitt.
For Hegel, the initial situation of the self vis--vis the other was that of
antagonism. Two or more desiring beings mutually recognizing each other only insofar
as they are about to commence the life and death struggle for the right to the object
they seek to incorporate. It is from this basis in antagonism that being, fighting for that
which transcends the self, is humanized. Whereas Hegel views this conflict as being
resolved through the institution of mastery and slavery (with the latter being the
surrender of the right to desire), with Carl Schmitt we find the initial conflict between the
self and its antagonists is the basis of politics as such. Politics, for Schmitt not only
entailed the existence of the antagonist but the ability to decide who that antagonist is and
how he should be treated.288 In the last instance, then, for Schmitt politics becomes
synonymous with sovereign power of life and death (in the most absolute sense.) 289
More importantly, however, the political situation also limits democracy: although he
admitted the necessity for pluralism on the grand scale of a multiplicity of states (at least
69

in Europe), 290 within states he found such a pluriverse unworkable. Given that a
political community is constituted in the antagonism between friend and enemy (or
the self and other, if you will) democracy could only be possible insofar as the
governing and the governed were the same people. 291 However, such is ruled out from
the beginning since antagonism is inherent within the political state (hence the
sovereigns role in keeping the peace through the declaration of an internal enemy.)
Therefore in every real state, there are a series of identities: the go verning and the
governed, the sovereign and the subject, 292 the people and their enemies and so forth.
By contrast, I contend that Fanons emerging vision of community (which, unfortunately,
was not fully elaborated at the time of his death) conceived of community as proceeding
from a basis in the nondominant engagement of the other. This was because, for Fanon,
communities based in antagonism towards the other were inherently abusive both
towards the others and towards their own members.
Again, for example, in his 1956 article on the Maghribi Muslim Attitude
Towards Madness, he illustrates this by drawing a stark contrasts between the modern
and Western society of 1950s France (which viewed the mentally ill other as
malevolent, intrinsically defective and fatally flawed) and another a supposedly tribal
and primitive society in the Maghrib (that is, the Western Sahara region) which viewed
the same mentally ill others as victims of malevolent forces beyond their control.
There he shows that the Westerners, as a consequence of their viewing the other as
antagonist, take a self-centered view of the actions of the mentally ill person even to the
point of becoming bitter for misdeeds committed when the mentally ill person clearly not
in control of their faculties. By contrast, the supposedly primitive, tribal group sees
70

exactly the same misdeeds committed by the mentally ill person from the perspective of
the person being in the grip of a malevolent forces controlling his or her behavior. Thus
they seek to free the person from those forces. Hence, e ven though the latter group
expresses their view of mental illness in the rather archaic vocabulary of jinns and
possession, Fanon makes it clear that functionally their conception of the patient was far
in advance of that customary in the West (both in terms of logical rigor and humanity
towards the patient.) This was precisely because the Saharans started from the position
of engaging the patient as community member rather than as their enemy.
Extending such analysis outside the clinic, in The Encounter of Society and
Psychiatry, Fanon finds the same pattern: in families where antagonism was the norm,
children developed unhealthy social interaction (becoming bullies where domestic
violence was present or developing low self-esteem where they are unwanted); the
worker under surveillance either collapses psychologically or else begins to conform to
the employers antagonized view of them and resort to such resistant tactics as calling in
sick or just not noticing the other worker (and thereby being unable to inform on them);
the discriminated minority is rarely truthful with persons of the dominant culture. In
all of these examples, at issue are not merely the specific practices of domestic violence,
or workplace surveillance, or even of racism but the fact that such things are an inherent
feature to a society where the other is approached from a position of antagonism. By
implication, then, this left the psychiatrist no other choice but to work towards changing
objective conditions of the society itself (inasmuch as they were rooted in or fostered
such antagonisms.) If s/he did not address the patients social environment, s/he faced
the prospect of all the efforts made toward curing the patient in the clinic being frustrated
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the minute the patient stepped out the door. As early as Black Skin, White Masks Fanon
even states as much:
... I should help my patient become conscious of his unconscious and
abandon his attempts at a hallucinatory whitening, but also act in the
direction of a change in the social structure.
In other words, the black man should no longer be confronted with the
dilemma, turn white or disappear ... if society makes difficulties for him
because of his color, if in his dreams I establish the expression of an
unconscious desire to change color, my objective will not be to dissuade
him from it by advising him to keep his place; on the contrary, my
objectives, once his motivations have been brought into consciousness,
will be to put him in a position to choose action (or passivity) with respect
to the real source of the conflict that is, toward the social structures. 293
Thus, these studies conducted by Fanon during his directorship of psychiatric
wards in Blida, Algeria and Tunis can be seen in continuity with his other better-known
publications, signaling a general direction of thought which saw the fundamental question
of community (its relation to its members and the basis from which that relationship
proceeded) as being that of engagement with the other. The choice was between
proceeding either from a position of antagonism or from a position of nondominant
difference. Without the latter basis, Fanon shows time and again how therapy is
compromised within the clinic (and recovery without.) However this had wider
implications in the field of politics, which he illustrates in describing the Pitfalls of
National Consciousness in his last work. There he gives the example of the postindependence nation whose independence movement started from the basis of
antagonism towards the white settler 294 (instead of the violence toward the colonial
antagonisms which he concretely advocated in A Dying Colonialism.) Whereas violence
towards the antagonistic relations served to render sexism an antiquated relic of another
age (in the eyes of the revolutionaries) 295 and formed the basis for rejecting anti72

Semitism296 and condemning torture as the practice of an underdeveloped nation,297 in

Pitfalls of National Consciousness the other path was taken, conflicts between the
urban and the rural, 298 the citizen and the foreigner, 299 the party member and the
nonpartisan, 300 and even inter-ethnic and religious conflict 301 become the norm until the
military (trained by foreign advisers) steps in to restore order. 302 The choice between
antagonism and nondominant engagement was thus ultimately posed as the choice real
independence and neocolonism.
Admittedly, Fanons ideas in regard to nondominant engagement were not
systematically worked out by the time of his death in 1961, however the examples he left
(especially in his clinical studies) are much in keeping with later concepts as complex
communication. Like Lugoness concept, the Fanonian engagement started from a basis
in the opacity of the other in Fanons case, this meant engaging person from an
entirely different cultural background than his. Although from that basis one would be
prone to error and even initial failures, such would serve only as a challenge not merely
to assimilate the text of the other to our own (seeing the self in the other, in Hegelian
fashion) but to rather change ... ones own vocabulary, ones sense of self, ones way of
living ....303 Fanons attempts in his clinical studies at rethinking community (and
enacting his vision of it through his engagements with the other) are instructive not only
in that they reveal a continuity between his early and later works but that he like the
later antipsychiatry movement saw the necessity for a fundamental shift in the way
Western society viewed itself in terms of its others. In not only seeking to think
community differently but to put his vision into practice, the body of his work and
especially his clinical studies serve as a vital link between the aspirations of the
73

antipsychiatry movements in Western countries and the post-World War II

decolonization movements in their former colonies.
However, his studies also reveal his awareness of the difficulty of engaging from
a nondominant basis the antagonisms of society run a mile deep and even in the most
forward thinking individuals must always be on guard against viewing engagement
merely from the perspective of assimilation (viewing a common language as being prior
to any engagement instead of the other way around.) Such a politics of assimilation,
Fanon found, was not only dangerous from a clinical viewpoint (allowing flawed clinical
methodologies to be papered-over through blaming a defective patient) but also
played into the worldview that saw ones community as universal and assigned the other
to the abyss of total devaluation before they are destroyed physically.304 This view
Fanon wrote (and spoke) against at every opportunity and in terms of his own practice he
stated in 1961:
... We have since 1954 in various scientific works drawn the attention
of both French and international psychiatrists to the diffic ulties that arise
when seeking to cure the native properly, that is to say, when seeking to
make him thoroughly part of the social background of the colonial type.
Because it is a systematic negation of the other person and a furious
determination to deny the other person all the attributes of humanity,
colonialism forces the people it dominates to ask themselves the question
constantly: In reality, who am I?305
Fanons professional and political commitments were thus linked by the desire to change
the objective conditions which made a society based in the denying the other the
attributes of humanity possible and key to doing so was first rejecting the assumption
that engagement with the other entailed antagonism. As Fanon shows in his studies, this
assumption could be found at work both in the abuse of patients in psychiatric wards and
in the surveillance of workers by their employers. In seeking to rethink the possibility of
74

a nondominant engagement with the other, we find in Fanons clinical studies the
beginnings of an interesting line of thought on community as such.

75

Frantz Fanons Clinical Studies (1954-1960)

In Chronological Order
Translated into English for the First Time

76

Sociotherapy on a Muslim Mens Ward: Methodological Difficulties

F. Fanon
J. Azoulay
Blida-Joinville Psychiatric Hospital
[1954]
Our attempts at organizing a psychiatric ward for Muslim men according to the
principles of sociotherapy have been quite rewarding from an experimental perspective.
Without hesitation, however, we will now illustrate some of the difficulties encountered
in these experiments especially in regards to the lack of objectivity (on our part) which
made many of our errors possible. As we were forced to humble ourselves before the
culture offered us and cautiously (but attentively) engage it, this engagement with the
consciousness of our patients double alienation due to the tyranny of subjectivity and
to what Piaget has termed sociocentrism has allowed us to reorient our research in an
entirely different direction. Fascinatingly enough, the indistinct notes which (from the
beginning) had awakened our interest would increasing formed a coherent whole.
The experiments which we relate to you in this article we, therefore, were made
possible by the fact that our only division was between Europeans and Muslims. These
control groups, moreover, did not mix being divided thus: 165 European women (on the
one hand) and 220 Muslim men (on the other.) Therefore, we should recall a few
particulars of the Blida Psychiatric Hospital.
Our arrival, our four colleagues were responsible for the observation of more than
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600 patients each under such conditions, any attempt to reorganize their wards along
the lines of sociotherapy would have been rendered impossible. With the arrival of a fifth
physician, the load was lightened to 400 patients and only then that sociotherapy was
possible. As far as sociotherapy, we found that (within the current practice of French
psychiatric care) the Saint-Alban Hospital constituted an organization whose functions
realized the sociotherapeutic maximum (both as a whole and in particular.) With the
former as our model, we began with our control groups as our initial point of departure
(in a sense, as our experimental milieu.)
To begin with, it was decided that there would be bi- weekly collective meetings,
separate staff meetings, and finally bi- monthly events involving the patients. Results
were not long in coming on the ward for European women. As early as the first months,
our collective meetings had become an integral part of life on the ward. With the
meetings being held at fixed times and dates, we placed great importance on our
punctuality in order to convey the importance of these meetings to those involved. Not
only did patients and physicians attend but also nursing sta ff wanting to become better
acquainted with the steps being taken. After a brief period of uncertainty, then, these
meetings soon caught the attention of our patients (on the womens ward.) In the
atmosphere created, succeeding interventions proceeded without much dead time.
From the start, we chose not to focus on minor disruptions but on the extent to which the
social architecture had begun to organize (and hence to which possibilities of encounter,
in the concrete, would begin to multiply.)
Christmas, with its traditional character firmly anchored, offered an occasion to
instill a series of determined behaviors in the heart of the ward. An immense dormitory
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of 65 beds was emptied and other wards were filled with patients and nurses, both male
and female. The medical corps and administrative services came in imposing numbers to
attend this first Christmas. Religious songs, choirs, carols, Nativity Scenes, even
Christmas trees, all carefully decorated by hands trembling with emotion were put to
use in assuring this festival the maximum solemnity. Two days later, during the course of
a collective meeting, we proposed that the patients regularly organize a festival on their
ward (and encountered hardly any opposition whatsoever.) [end, p. 1095]
Certainly, in the beginning, organizing the ward was difficult but today many of
the small incidents that occurred then have disappeared (after a period of laxity on the
part of the patients and staff.) It was not a question of always returning to the same
delirious patient but rather of even integrating the catatonic, the incontinent, or the
sitiophobic who had never been thought of. With the festival prepared, invitations sent
out, and the scene arranged by patients with the aid of one or two nurses, we attended
merely as spectators. The festival thus took on a truly therapeutic character, for instance,
when the paranoic responsible for the chorale Sombreros et mantillas observed (from
the corner of her eye) that a catatonic, losing the thread of their song, was compelled to
begin moving again.
Besides the festivals committee charged with organizing such events, there was
also a cinema and a discotheque committee. As cinema is not merely a succession of
images accompanied by sound but, ideally, an unfolding of life, of history, the cinema
committee sought to give sense to the cinematographic work by choosing films and
commenting upon them in a special number of the journal (Notre Journal.) Similarly, the
discotheque committee organizes musical gatherings where it is possible to listen to
79

recordings by Luis Mariano as well as classical pieces like La Symphonie Inacheve the
latter having been commented upon by a patient.
Notre Journal, our weekly journal, was directed by two committees: a journal
committee (which selected the proposed texts) and a printing committee. The editorial,
written by a member of the medical corps, examines certain, particular, aspects of
psychiatric practice in order to stimulate thought about hospitalization as such amongst
the patients and staff. Again, in the beginning, contributions by patients were rather
monotonous: I thank the doctor for his good care or Id like to leave soon. Now, as
indicated by a recent editorial, the journal reflects the progress being made: although one
finds the same names, there are now invitations to festivals, musical auditions, and even
complete accounts of excursions, promenades, films of the week, or (more generally)
events of a collective nature.
Finally, ergotherapy occupied an important place in the life of the ward and thus
we searched for ways to harmoniously integrate it into the rest of our activities. Aside
from domestic tasks, there is a knitting workshop (managed by a nurse) where several
patients manufacture the same piece. Elsewhere, patients stitch and embroider
tablecloths, napkins, and curtains. More recently, weve begun a needlework studio
charged with manufacturing robes the fabric for which is obtained by the patients
themselves (through their individual savings.) For patients who have been here five or
six years, one can only imagine the importance of these things: of the flowered or striped
fabric, bright or dark according to the mood of each, breaking the monotony of the
hospital gown. One can distinctly observe the ceremony of the woman trying on her
robe, remaining immobile as she is delivered into the hands of expert designers. The
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institution was thus too strong to leave the patients attitude unmodified vis--vis their
milieu. She could no longer live her madness in isolation.
These activities, which we have briefly traced, formed the fabric of an
increasingly rich social life. The European womens ward was able to organize without
much difficulty because we already had a tried and true method. Thus, after the first
months, we sensed a rapid, dense, fertile, grasp of the concept on that ward. The
atmosphere had palpably changed and we were able to remove all restraints without fear
of difficulty. Not only was life in the asylum rendered less difficult for all, but the
number of departures manifestly increased.
*
* *
Our rapid and easy success on the European womens ward only underscored the
complete and total failure of the same methods on the ward for Muslim men. [end, p.
1096]
Placing our efforts in the same order but a different setting, we were thus able to observe
their successive failure. Knowing that group psychotherapy would be difficult with
Muslim patients, we met with the patients only after successive colloquia with the
nursing staff.
In the great dining hall, the table covered with a cloth and decorated with flowers,
the meeting was convened with the utmost care. The physicians were surrounded by
interns, observers, and nurses, in order to augment the ceremonial value. In accordance
with such, the most agitated patients were sent into the courtyard. From the start, contact
was difficult to establish (given that we did not speak the same language as the patients.)
Thus we sought to surmount this obstacle by choosing from among the Muslim nurses an
81

intelligent, articulate, interpreter (with whom we took care to explain, in detail, what we
sought to accomplish.)
During the meeting, we tried to interest the patients to transform them from an
abstract, impersonal, multitude into a coherent group animated by collective concerns.
We spoke of festivals, films, of the journal, yet only rarely did this meet with silence:
quite unconscious of our existence, one patient continued with his stereotyped
movements, two others argued loudly with each other, and a third left to exercise in the
courtyard. Precious few realized the importance of our presence or accepted our attempts
at dialogue. In fact, the only one to accept our approach was a persecuted paranoic who
spoke good French: yet, far from trying to interest his companions in our approach, he
more or less consciously sought to distance himself from them.
Confronted with this general disinterest, we were unable to find themes to exploit.
As the silence prolonged, it accentuated the impression of malaise. After several weeks,
the collective meetings (which originally lasted an hour) became progressively shorter
constituting an empty ceremony, absurd and devoid of sense and thus (after some
hesitation) we decided to discontinue them altogether. We then tried something else:
asking the nurses to each choose ten patients and meet with them each night for an hour
of discussions, games, or songs. With these, we gave precise directions because it
seemed to us that cooperation and the creation of the team-spirit were at stake. From
the nightly reports of these meetings (written by the nurses responsible), notice the first
night:
... weve met again and have played the games of hide and seek, cards, and
dominoes. Atmosphere pleasant, but some patients are not interested in
games.
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Much later:
... an easygoing game of pelote cavalire was played by the following
patients ... who were in the care of attendant K. In the beginning the game
seemed complicated but once we explained the rules to them things went
smoothly.
The following days found collective activities far more restrained and the reports more
pessimistic:
... we started with ten patients, but after ten minutes only six remained.
M., N., B., and B. were eagerly playing cards, B. and L. left to get some
rest (on the pretext of being tired from all the work.)
Or better:
... patients O., M., S.N.P., refused to attend the meeting, saying they were
tired. Other patients have chosen to play a quiet game of dominoes
without discussion.
Evenings were thus reduced to listening to Oriental music (on the radio.) Patients
remained indifferent and the nurses interpreted our activities as drudgery. After several
tries, and despite our repeated encouragement, the nurses expressed their dissatisfaction:
Theres no way to interest them. After they eat, they want to sleep yet we lock them
out of the dormitories.
Parallel with our nightly discussions we also sought to organize monthly
festivals on our pavilion. We had planned sufficiently in advance because we knew this
would be difficult. The festival was to consist of a choral and a theatrical part however
it was difficult to find even two nurses willing to take charge in organizing it. After two
weeks of asking repeatedly, our only response came from an older nurse murmuring
and shaking his head. The others remained silent. The nurses did not put [end p. 1097]
in enough effort (we thought) and, irritated by their ill-will, we confronted them on their
lack of effort: if it could be done in the European womens ward, it could be done here as
83

well! Thus our staff was not grieved in the least to be replaced by others who equally
failed, as well. Others still were not much more successful and so, with these last, we
realized that a change in our approach was needed. It simply wasnt a matter of our
staffs laziness.
In the meantime, our attempts at organizing the festival failed miserably and we
sought to resolve the problem by offering diversions. Although our patients assisted in
the European womens festivals and attended the cinema regularly, we noticed that if the
wards director forgot to ask them to help with the womens festival none would come.
At the cinema, they would leave the chapel in the middle of the film in order to smoke.
Thus, in regards to our collective meetings, recreative events, and other group activities,
we had to conclude that our advance had been checked.
As for the journal, which ought to have served to cement the social group, the
Muslim patients remained estranged. In six months, only one contributed an article: a
paranoic upset that women were taking on masculine roles. Only precious few nurses
read it, as well. We werent much more successful with ergotherapy either.
There was certainly a workshop in the hospital (located in the Mosque) for
manufacturing straw hats, baskets, and placemats which employed a number of our
patients and others worked in the interior of the ward or in general services but we
could not consider this work as having therapeutic value, since tasks were assigned at
random and patients accepted them, above all, to avoid the courtyard. Often they worked
only long enough to buy a cake or cigarettes, and then refused to continue (allegedly
because of pains in their legs or stomachs.) This is why we decided to create an
ergotherapy workshop. However, having set aside a month and a half to train a nurse in
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the raffia technique, we entrusted around fifteen insulin therapy patients to him (who
would work part of the morning and all of the afternoon.) When we visited, we noticed
the patients were (for the most part) unconcerned with, and completely indifferent to, the
completion of the common task: as soon as the monitor would turn his back, they would
leave (preferring, instead, to help one of their companions clear a plot of land with a pick
and shovel.) Despite our repeated encouragement, only three placemats were
manufactured and soon we sensed that it was useless to continue this exercise any further.
After three months, not only could we not continue but despite our efforts to
interest Muslim patients in commencing the type of collective life we had organized on
the European womens ward the atmosphere remained tense. At all times there were a
significant number of incontinent patients and, by the end of the day, there was hardly
enough linen for them to even maintain themselves. During meals, the noise in the
dining halls was deafening disproportionate, even to the number of patients. Patients
would take pleasure in throwing their food off the table, spinning their plates on the floor,
and breaking spoons. Under these conditions, it is easy to see why cleaning comprised a
significant portion of the staffs activity. [end p. 1098]
The frequent disputes between patients, into which nurses only would intervene at
their own risk, served to maintain a menacing climate on the ward. The nurse was afraid
of the patient and even the barber would demand tha t patients be restrained before he
would cut their hair. For fear of the patient, or to punish them, patients were placed in
solitary confinement sometimes without a shirt, mattress, or sheets. As a preventative
measure, these eternal recurrents were often tied up and, as amply demonstrated by
Paumelle, the same rhythm, the same vicious circle, repeated itself: agitation, restraint,
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agitation all reinforcing the totalitarian spirit of the ward. Every new effort on our part
to break our wards punitive structure was welcomed by inertia and, sometimes, clear
hostility (disguised as irony): This patients struck and broken a window should we
restrain him or not? What do you think? We were powerless before the arguments of
our decorated staff, consecrated by years of experience in the asylum: Youre still new
to Algeria, you just dont understand. When youve been here fifteen years, youll
understand.
Thus, after only a few months, the contrast was striking. On the European
womens ward, the journal appeared weekly, theatrical performances were conducted
regularly, and agitation had disappeared

replaced by a therapeutic atmosphere; on the

Muslim mens ward, on the other hand, we ran into the aforementioned difficulties
there always a significant number of patients in restraints and, despite our many efforts,
there were no signs of improvement. Gradually it became clearer that this was not
merely a matter of coincidence, laziness, or bad faith. We had taken a wrong turn, and
had to figure out why: we had to clear this impasse.
*
* *
In the meantime, we studied the Muslim mens ward in depth: both the character
of the patients occupying it and their milieux of origin (outside of the hospital.) We had
naively thought our division to be of a whole, with adaptation of Western contexts to a
Muslim society merely being a matter of technical evolution. Having sought to create
institutions on the Muslim mens ward, we had forgotten that every step on this path must
be preceded by a tenacious interrogation of the concrete, real, and organic bases of the
preexisting society. What errors in our judgment had led us to believed Western- inspired
86

sociotherapy possible in a ward for Muslim patients, that structural analysis was possible
with the bracketing of the geographic, historical, cultural, and social contexts?
(1) First of all, it is said that the North African is French thus, insofar as
attitudes being different from one ward to another, one does not find what one is not
looking for: in short, psychiatry then unthinkingly adopts the politics of assimilation. As
the North African is French, there is no need to understand them in their cultural
originality, rather, the effort must be made by the native (and it is in his interest) to
adapt to behaving as the type of man proposed to him. And such assimilation does not
suppose reciprocity either: instead, one culture must disappear for the benefit of the other.
Thus, even aside from our use of an interpreter, our attitude was generally not
adapted to our patients (in the Muslim mens ward.) In fact, a revolutionary attitude was
necessary for we needed to pass from a position where the supremacy of one culture
was self-evident to one of cultural relativism.

Hence, with refere nce to Piaget, we found

the notions of adaptation and assimilation crucial to understanding our failure.

(2) Most importantly, we should say that those who preceded us in elaborating the
data of North African psychiatry were a bit too limited to motor, neurovegetative, and
somatic phenomena [end p. 1099]
The work of the Algiers School, which has revealed several particularities of the North
African, has not (to our knowledge) proceeded to the functional analysis which they
profess to be indispensable. This would require a change in perspective or, at the very
least, a following-through on their initial thought. In other words, we must grasp the
facts of North African society from within that very totality (a grasp which Mauss
viewed as the guarantor of an authentic sociological study.) This would entail a leap to
87

efficacy, a transmutation from values to their realization. Thus we must pass from the
biological to the institutional, from the natural to the cultural and in fact, the biological,
psychological, and sociological are intrinsically tied (only held as separate through a
mental aberration.) It was thus because we had not integrated the notions of Gestalt and
contemporary anthropology into our everyday practice that we encountered the
difficulties mentioned above.
For example, during the six months Muslim women had attended festivals in the
European pavilions, they mildly applauded in the European style. However, once a
Muslim orchestra arrived at the hospital for a performance, we were quite astonished to
hear their applause this time: short, high-pitched, repetitive vocal modulations. They
had thus reacted to the configurational ensembles in accordance to the requirements of
those ensembles. It was evident to us, then, that we need to find the gestalts which
similarly facilitated reactions already inscribed on such definitively elaborate
personalities.
Sociotherapy is only possible inasmuch as it takes account of social morphology,
that is, the forms of sociability. Thus we asked ourselves What were the biological,
moral, aesthetic, cognitive, and religious values of Muslim society? How did the
Muslim react from an affective or emotional point of view? What were the forms of
sociability which rendered possible the attitudes of the Muslim? We had before us
institutions we did not understand, to what did they correspond? A functional analysis
had to be performed in order to facilitate our task. In a work now in progress, one of us
will demonstrate the complexity of North African society (which today is subject to
extremely profound structural modifications.) However, now it will suffice to merely
88

recall a few element characteristic of this society.

Traditional Muslim society is a society theocratic in spirit. The Muslim religion is
more than just a philosophical belief it is a way of life which regulates the group and
individual in a strict fashion. In Muslim countries, religion impregnates social life
leaving no room for secularism (as law ethics, science and philosophy are infused with
it.) Alongside the properly Islamic, tradition inherited from ancient Berber customs also
forcefully intervenes (explaining the rigidity of the Muslim social context.)
Muslim society is also gerontocratic. The father directs the life of the family and
it is to him (or, by default, the older brother or uncle) that one directs themselves for
guidance on all matters of importance. Family, moreover, is quite extended sometimes
to the point of whole villages sharing a surname! and it tends to identify itself with a
clan (the genuine social group in Muslim Algeria.) Decisions at this level are made by
the Djem a municipal council at the head of which one finds a president (of whom the
administration has only recently recognized the importance.) In effect, then, until
recently there existed no nation but rather a familial, clannish, community.
Equally, we must insist on the ethnic complexity of the region. Kabyles form a
significant minority amidst the Arabic population. These groups, although united by the
Muslim religion, are clearly separated by marked differences in language, tradition, and
culture. Kabyles, of Berber origin, inhabit the mountainous regions their villages,
perched atop the summits of hills, constitute the element where tribalism remains
strongest. The Arabs, by contrast, inhabit the plains and cities. Amongst them, one finds
not only farmers but also merchants and craftsmen. [end p. 1102]
We did not address other local particularisms (for instance, the Bedo uins, Southern Arabs,
89

Mozabites, and Chaouis) because they were less significant to the experiment on the
Muslim mens ward: out of the 220 patients on the Muslim mens ward, there were 148
Arabs and 66 Kabyles, and (together) only 6 Moroccan Chaouis and Mozabites. Lastly,
let us say a bit about the present-day living conditions of our Muslim patients (which
would largely explain their state of ignorance and traditional primitivism.)
Before the French conquest, land was owned communally and the notion of
wealth was tied to the notion of useful, workable, land (and consequently the possession
of a yoke or a plow.) The possessors of such instruments were the true landowners. The
installation of the French entailed a transformation of landownership and the
redistribution of goods: communal ownership was divided between the possessors (who
became private owners.) The members of the old tribe were indeed driven into poverty,
but one to which proletarianism was unknown. Today, however, the pro letariat exists:
outside of the small minority of great landowners (European and Muslim), and the mass
of small proprietors (fellahs) who live difficultly by cultivating a small plot of land by
primitive technique, there exist those who would envy even of the fellahs meager living.
These latter having become destitute, their sociological ties to the tribe increasingly
loosened, soon they sold their labor as khammes or day- laborers.
Thus, in this previously homogeneous society, there is now disassociation
between the small proprietors (on the one hand) and shepherds, sharecroppers, and daylaborers (on the other.) Moreover, the latter proletariat continues to form itself today: as a
result of the extension of modern agricultural techniques by the great landowners, masses
of unemployed agricultural workers are lured to the cities by hunger, condemned thus to
the proletariat (and sub-proletariat) by the absence of industry (further accentuating the
90

social disequilibrium.) In connection with this, we must emphasize that many in the
Berber population have immigrated (as seasonal workers) to France either to find
employment they could not find at home or to complement a meager harvest.
The development of the sedentary class, which results in the fracturing of the
group, thus rejoins the development of nomadism. With difficulty, imagine the impact of
nomadism upon the ancient North African: the tribes of the south arriving almost at the
edge of the sea, where the tide washes the sand and steppes and breaks across the steep
plateau. Yet the French occupation has naturally entailed a constant regression to
nomadism which resolves itself in two terms: sedentarism and the sale of labor
(proletariansm.) However, the seasonal workers remain outside the sedentar y group they
come to aid. Thus, whereas the old nomadism maintained traditional authority and group
cohesion, this new circulation of individuals one sees today operates outside of all tribal
conventions and contributes to the hastening of a dangerous detribalization. The decline
of the old nomadism is as inescapable as the rise of its replacement: proletarization.
These factors which favor the dissolution of both settled and nomadic groups thus explain
the formation of Bidonvilles at the edge of large cities which constitute not only a
defiance of aesthetics and planning but also a grave danger (from a sanitary and moral
point of view.)
By way of example, then, we illustrate our finding of the social composition of
the Muslim mens ward:
Of 220 patients, we found:

35 fellahs, that is, those who cultivated a plot of land

75 agricultural workers, sharecroppers, or day-laborers
78 workers with regular employment (bakers, painters, etc.)
5 intellectuals
91

26 without profession

However, these numbers require interpretation. For instance, one might think there are a
relatively high number of skilled workers amongst our patients (76 out of 220.) In
reality, these workers are merely those (uprooted from the countryside) who were able to
find any work whatsoever within the city. In fact, of the 78, one could only isolate
twenty with even the slightest trace of specialization. [end, p. 1103.]
Regarding the 5 intellectuals, these were all clearly native school teachers with little
more than an elementary education.
The problems of these uprooted workers have far-reaching consequences:
although the reasons individuals leave traditional society are, by themselves,
undecipherable, the number of such individuals is constantly progressing. Although
badly analyzed within current social science, these uprooted elements entail domestic,
economic, and political fragmentation: traditional society, though often seen as fixed, is
fermenting at its base. Again, these few notions though all- too-brief and requiring
further development sufficiently illustrate the specificities of Algerian Muslim society
which must be taken into account in order to create a basis for sociotherapy amongst
Muslim patients.
*
* *
Now we shall try to understand the reason for our failure.
As we have said, the gatherings in our pavilion have did not prove fruitful. This
was essentially because we did not speak Arabic we had to resort to two interpreters
(Kabyle and Arabic.) The need for interpretation, in turn, fundamentally vitiated the
psychotherapeutic physician-patient relationship because the patient normally encounters
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the interpreter in his relations with the government or else the criminal justice system. In
the hospital, this same use of an interpreter spontaneously provokes the kind of distrust
which makes communication difficult. Further the patients discourse becomes
animated in our presence when he tries to explain that he is cured and should be released
immediately and he often forgets the presence of the interpreter and addresses us
directly (for the interpreter, he feels, cannot convey with the same feeling what he
wishes to express.) One can easily see that such a dialogue illustrates a disturbance in the
phenomenon of encounter.
Yet interpretation not only tortures the patient for the physician (and, above all,
the psychiatrist) arrives at his diagnosis through language. With translation, however, the
gestural and verbal content of language are not perceived in a synchronic fashion.
Pantomime is expressive, and gestures abundant, but one still must stay to the end of the
discourse to grasp the sense but, at that moment, the interpreter says in two words what
the patient has recounted (in detail) for ten minutes: He says someone has taken his
land or His wife is cheating on him. Often the interpreter interprets the thought of
the patient according to stereotyped formulas stripped of their content: He says that he
hears djnouns but is this delirium real or induced? Thus the use of interpreters, while
perhaps valuable when it is a matter of explaining a single word or transmitting an order,
is entirely useless when one needs to engage in dialogue and only dialogue, the
dialectical exchange of question and response, is capable of vanquishing reticence and
making evident abnormal, pathological, behaviors.
Finally, as Merleau-Ponty has said, To speak a language is to support the weight
of a culture. Not knowing Arabic, we could not know which cultural or affective
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elements of their patrimony were capable of availing their interest. Hence, with the
European women, it was easy to begin discussion on a record by Tino Rossi or a film by
Fernandel. With the Muslim man, such discussions were cut short because there was
nothing to say.
Similarly, given a little hindsight, our attempts to organize a festival appear very
nave for the notion of festivities outside of familial or religious events is quite abstract
to the Muslim. In addition, the content of their collective rejoicing appear to us
essentially different from Western festivities: for instance, it was difficult a chorus
because Muslim men dislike singing in groups (and in the house one does not sing out of
respect for the father or elder brother.) The same was true amongst the Muslim nurses o n
our ward. Similarly, theatrical pieces were not performed because (in traditional North
Africa) theater as we know it does not exist. Although Arabic theater certainly exists
today in the large cities, its existence is quite recent and outside the cities the actor or
singer is one who remains outside the social group. In the villages or douars, instead,
there are itinerant storytellers who wander from place to place bringing news and
folkloric tales [end p. 1104]
accompanied by a rudimentary lute (or derbouka), evoking the troubadours of the Middle
Ages.
The smaller gatherings fared little better. If we review the reports of such
gatherings, we see that (from the beginning) there is talk of hide-and-seek and pelote
cavalire. Thus, much like the nurses, we had insisted on indifferently distinguishing our
European and Muslim patients since these games promoted team spirit (given that, in
both games, one had to account for the reactions of ones companions.) The problem,
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however, was that the Muslim rarely played such games in his youth for it is at school
where one learns to play hide-and-seek or cops-and-robbers, where one acquires team
spirit. At around the age of ten or twelve, however, the young Arab is a shepherd (or
else aiding his father in small tasks.) Evening activities had to be inspired by reality and,
in reality, Muslim men gathered in Moorish coffeehouses after work. Seated around a
table playing cards (or better, lounging on a mat discussing current events or listening to
the radio) they would pass the time drinking tea or coffee. This our experiment had
shown well: after a few weeks, when the nurses had lost initiative, those patients who
consented to remain awake would only listen to the radio.
The diversions organized by the hospital were not as vital a need for the
Muslim as for the European. Thus (in the cinema) the films that were shown, for the
most part, did not provoke emotional engagement. We refer you to a few of the films
shown recently: Little Women, King Solomons Mines, Les noces du sable, La duchesse
de Langeais, Crisis, Rio Grande, Therese Raquin, etc. Only action films without deep
psychological or sentimental plots were even remotely followed. More than merely
primitivism, one can without doubt attribute such disinterest to the impossibility (for
the Muslim) of comprehending the reactions of Western personages. The example of
Cocteaus Les noces du sable (a film which relates the adventures of a man who searches
for his fiance amongst the nomads of the Sahara) is particularly eloquent: although the
costumes and dcore were, in principle, North African, the psychological plot remains
Western. It did not interest the Muslims because they were not able to fully participate in
the action or to identify with the characters. The same can be said for the other films. To
the contrary, in the action films, the plot was simple and the images spoke for
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themselves. The same, however, even applied to our European patients: if one sung a
popular song, performed Les preciuses ridicules, Le mdecin malgr lui, Cyrano de
Bergerac, or a piece by Courteline or Colette, all remained insensible at best, vaguely
awakened from their torpor when an actor threw a glass of water or fought with another
character.
With the journal, our failure was still clearer: as the journal can only reflect the
social life of the hospital, it can be of very little interest to those who remain excluded
from that life. This is why even patients who could read and write never contributed
articles. However our failure was, in large part, due to the fact that most of our Muslim
patients were illiterate. More precisely, of the 220 on our ward, 5 could read and write
Arabic, 2 could read and write French. A few others were unable to write. Further, of
those who were considered literate in any way (16 altogether), only 6 were educated past
the secondary level. In the beginning we thought we could remedy this problem by
having a nurse write articles for the patients (as was the case with Europeans who could
not, or were unwilling to, write.) However, utilizing this procedure was practically
useless. In reality, given the illiteracy prevalent in Algeria, culture can be said to be more
oral than written and education, above all, is by way of speech.
However, there exists in every group a few literate persons charged [end p. 1105]
with reading and writing for the rest. Indeed, it is thus easy to recognize the handwriting
of the same Taleb (or public scribe) in the letters we receive from the parents of
patients who lived in the same douar. And again, we have seen the importance of the
storyteller, wandering from village to village, bearing news, folkloric tales, epics

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recounting events of centuries past, and assuring thus the cultural linkages between
different regions.
To conclude, we should now speak of ergotherapy. In highly industrialized
Western nations, one can easily organize readaptation departing from already existent
possibilities; for the Algerian Muslim, who lives in a context much more feudal in this
regard, such readaptation is much more difficult. In traditional North Africa, man works
the land and does not specialize although he does practice a rudimentary artisanate
outside of the cities, he dislikes working with wool or raffia: this is womens work (for
women weave baskets and mats.) Although one can seek to organize raffia, pottery, and
sewing workshops in the hospital, it seems to us better to confine such work to Muslim
women. For men, we must take our point of departure from the most general and firmly
anchored dispositions of the personality of the patient (and this is true even for deliriants
and catatonics.) It will suffice to give them a pick and a shovel which they will use to
break the earth (and without which one will have to force them to work.) These peasants
are close to the land, one with it: if the result of ergotherapy is to attach a particular plot
to them for cultivation, then such will truly it will be a factor in their rehabilitation.
Ergotherapy can only insert itself within a socially specific activity.
*
* *
We have definitively shown why our first attempt at implementing sociotherapy
among Muslim patients was repaid in failure. Nevertheless, we also believe that this
failure was not in vain (inasmuch as we have understood its reasons.) Since then, in fact,
we have modified the focus of our efforts and have been able to see tangible results.

97

The creation of a Moorish coffeehouse in the hospital, regular celebration of

traditional Muslim festivals, and periodic visits by professional storytellers are already
concrete facts. Further, at each event, the number of new patients engaged in activities
increases. Although this new social life is only a beginning, we believe now that our
methodological errors are behind us. [end p. 1106]

98

The Conduct of Confession in North Africa

Messrs. Fanon and Lacaton (of Blida)
[1955]
If he is to answer the principal question posed to him namely, of whether or not
the accused was in a demented state during the commission of a crime the physician
charged with psychiatric evaluation is obliged (at the very least) to inquire into the ideas,
values, and mental attitudes of the accused. From these, then, he is to ascertain how the
act in question was decided and realized. In medico- legal practice, then, the act itself, its
justifications, the conflict that this act attempted to resolved and these, seen from the
perspective of the accused are always of the utmost importance.
The psychiatric evaluator, then, should try to discern the truth of the act which is
fundamentally the truth of its author. For an author to deny his own act, to reject it,
would be to fundamentally alienate himself, whereas (on the contrary) to claim and fully
assume it (as in Hugo, or like the heroes of Sartre, saying he is nothing more than his
own act) would be to embrace the absurd and make sense of it. The internal coherence
of the criminal act having been established, fault having provoked self-condemnation and
the like in his conscience according to the respondent, a veritable segregation
confession provides for the author of the criminal act his ransom for reinsertion into the
social group. Only, how is it not noticed that such a favorable resolution is impossible
without a pre-existing, reciprocal recognition of the group by the individual (and vice
versa)? On this point, it seems of interest to provide a few, brief observations furnished
99

by medico- legal practice in Algeria. The psychiatric evaluation of Algerian Muslims will
allow for a rapid appreciation of the particular problem of confession. [end p. 657.]
If we take what the respondent states to be a general rule (in effect, that the
accused has confessed before the trial), notice that in Algeria the psychiatric evaluator
often finds himself placed before an accused who denies in an absolute fashion: to the
point of even claiming not to know why he is being detained. If we confine ourselves to
Berber customary law, in cases of crimes committed by Kabyles and there, to
traditional rules from which inflexibility and rigidity have not been shaken, e.g., murders
or attempted murders connected with inheritance, the sale or exchange of land, or again
marital infidelity, and so on we find the proportion of such denials is at times quite
significant (nearly sixteen of every twenty accused.) However, even under French
jurisdiction, the dossiers of preliminary investigations are (in many cases) quite eloquent.
At times denial is established from the very beginning, but much more o ften a
complete confession is obtained by the preliminary investigators including the motives,
the narrative of the events, and the concordant constitution of the scene of the crime.
During the course of the trial, this does not change much but then (in principle, after one
or two months of detention) the accused retracts his confession. He denies them en bloc
and, in a large number of cases, claims to have made his confession under duress. This
total retraction becomes definitive and unshakeable, but the accused does not try to prove
his innocence. He is innocent. His fate is in the hands of Blind Justice: if she decides, he
will be punished. He accepts it all in the name of Allah ... (we will return to this genuine
submission later.)

100

We can easily imagine why the psychiatric evaluator would be ill-at-ease under
these conditions. He is truly not able to respond to the fundamental question (stated
above), being deprived of the diagnostic value of the type of confession spoken of by the
respondent (who has shown the great difficulties that follow from a retraction.) It is no
longer a matter of the retaking of the act by its author: instead, the act reveals itself to be
without an author and criminological comprehension impossible. Only the dossier
remains. The charges it contains, as we have seen, often weigh very heavily against the
accused. The former have reconstituted the crime, revealed the imprint of the weapon,
and many witnesses affirm to having seen him strike (although in some cases, even the
witnesses retract their testimony as well.) Yet, at the moment of the trial, the psychiatric
evaluator is in the presence of a lucid, coherent, man who proclaims his innocence. [end
p.658.]
The assumption of the act and by extension the subjective assent to the sanction (the
acceptance of condemnation and likewise culpability) are totally absent. The truth of the
criminal cannot be found by the psychiatric evaluator.
Perhaps we should reconcile ourselves to embrace an ontological explanation and
ask if the indigenous Muslim has not really made a contract against the group which
henceforth holds him under its power? Does he feel bound by a social contract? Does he
feel excluded by his guilt? Then by which group? The European? The Muslim?
What significance will the crime, the trial, and the sentencing have from then on?
Certainly one can pose a question by failing to respond to the previous. One can, thus,
say that the North African is a pathological liar. This notion is easily admitted.
Magistrates, police officers, and employers can give numerous, convincing, examples (or
101

else state that the North African is lazy, underhanded, etc.) But can such simplification
permit us to find the truth which was so far out of reach? The orchestration of falsehood,
which we have briefly described, ought to require a more profound explanation and, in
any case, the liar is someone who constantly poses the question of truth to himself.
Thus, to affirm that a race suffers a propensity for lying, for voluntarily dissimulating the
truth, or that it is incapable of discerning true from false, or again that it does not
integrate the data of experience because of a supposed phylogenic deficiency, is merely
to dispense with the problem of retraction without resolving it. The path to a solution,
perhaps, passes by way of the notions mentioned at the beginning of this talk.
Recall that the reinsertion of the criminal by his confession depends upon the
recognition of the group by the individual. However, one cannot have reinsertion if there
was not insertion to begin with. According to the respondent, anytime many ethicosocial processes coexist, a group is not homogenous and harmony is absent. The
subjective assent of the criminal which grounds and valorizes the sanction will not be
accorded under such conditions. [end p. 659.]
The fundamental acceptance of condemnation supposes a coherent ensemble of
collective attitudes, that is to say, an ethical universe. For the criminal, to recognize his
act before a judge is to disapprove of that act, to legitimize the interruption of the public
into the private. Does the North African not refuse all of this in his denial and retraction?
Undoubtedly, we have seen concretely the total separation between two coexisting social
groups where, alas, the integration of one by the other has not begun. The refusal of the
accused Muslim to authenticate the social contract by confession of his crime, we
propose, signifies (to him) that his often profound submission in the face o f power
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(judicial, in this case) is not to be confused with the acceptance of such. These few
remarks merit a much more profound study, nevertheless they have shown the immense
and serious problem of the psychiatric evaluators task in Algeria (as we had originally
intended.)[end p. 660.]

103

Current As pects of Psychiatric Care in Algeria

J. Dequeker
F. Fanon
R. Lacaton
M. Micucci
F. Rame
(Blida-Joinville Psychiatric Hospital)
[1955]
The decision to devote an issue of lInformation Psychiatrique to Institutions in
French Overseas Departments appears to us particularly fortuitous, at a time when
Algeria suffers a lack of thousands of beds needed for urgent care; when it responds to
demands for the repatriation of Muslims interned overseas; and where as we speak
the Orleansville earthquake has removed yet another 200 hospital beds.
*
* *
The problem of psychiatric care in the colonies had been posed in its entirety by
the Reboul and Rgis Report to the 22nd Congress of Alienists and Neurologists of 1912.
The participants in the Congress subsequently made a promise to define and implement
the conditions for adequate psychiatric care in the colonies. In Algeria, however, the
implementing of these recommendations would have to wait until 1932 when, under the
impetus of Physician-General Lesnet and Professor Porot, an active interest was taken in
this regard. The decree of March 14, 1933 regulated the recruitment of physicians to
psychiatric facilities in Algeria specifically physicians from metropolitan France. In
104

addition, two orders issued on August 10, 1934 regulated the operation of psychiatric
facilities in Algeria: first line wards, being acute care and observational units, were
established in Algiers, Oran, and Constantine; the second line, at the Blida Psychiatric
Hospital, operated according to the provisions of the Law of June 30, 1838. Thus we
entered the path of realizing this plan and, in July of 1935, it was finally put in place with
the opening of the acute care facility in Constantine.
In his 1938 report to the Congress of Alienist Physicians and Neurologists (held in
Algiers), Henri Aubin listed the resources of Algeria:
First line wards:
Algiers: 43 beds
Oran: 55 beds
Constantine: 62 beds
The Blida Hospital, at the time had a population of 1000 patients already well over
capacity. Since that time Professor Porot, in his capacity as technical advisor for
psychiatry, has never ceased in appealing for additional beds. He currently estimates a
need for 5000 beds and recommends the construction of psychiatric hospitals in the
departments of Oran and Constantine. Unfortunately, his counsels have not been heeded
and since the creation of psychiatric annexes (in 1938) there has been no significant
construction of psychiatric facilities. From a psychiatric point of view, these annexes
constitute an unsatisfactory solution and the situation, as of 1954, presents itself thus.
Algeria is an area having 10 million inhabitants: 8,500,000 Muslims and
1,500,000 Europeans. Psychiatric care in Algeria, in principal, requires a first line and
second line of psychiatric facilities in each department. In the Algiers department, that
first line is found at the Mustapha Hospital (the hospital of the Algiers Medical Faculty)
with 81 beds. The Blida-Joinville Psychiatric Hospital, with 2,200 beds along with its
105

annexes at Aumale and Orleansville (300 and 200 beds, respectively) constitute the
second line. The Oran department, with its first line at the Oran General Hospital,
possesses a total of 545 beds. In the Constantine department: the first line, Constantine
General Hospital, possesses 76 beds; the second line consists of holding cells in Bougie,
Philippeville, Guelma, and Bordj-Bou-Arreridj with a total of 16 beds between them [end
p.1107]
These psychiatric facilities are staffed by one psychiatrist for the Oran
department, one for the Constantine department, five for the Blida Hospital, and one for
the Mustapha Hospital (the Faculty Clinic manned by Professor Manceaux and his
interns) which is to say that, for a population of 10,000,000, there are only 8
psychiatrists and little over 2500 beds. Moreover, in 1952, 536 Muslims were being
treated in metropolitan hospitals. Factoring them in, one finds little more than 1 bed for
every 4000 inhabitants. But if we take into account that the Blida Hospital was designed
for a maximum of 1,200 patients, with the progressive overcrowding gradually reducing
its efficiency, we have scarcely 1 bed for 7000. Therefore, it is not hard to imagine the
problems this poses for the psychiatrist working under such conditions. In this study, we
propose to illustrate under three circumstances (admission, hospitalization, and discharge)
that the practice of psychiatry is very difficult these days.
Admission
At a time when (in the metropole) patients seeking admission to a hospital,
supplied with a certificate of placement and order of admission, are obligatorily received,
the same is not the case in Algeria. There admission is based on the number of vacancies
(that is, discharges or deaths.) On September 23, 1954, the 850 admissions recorded by
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the Bureau of Admissions at Blida were distributed as follows:

European Females: 33
Indigenous Females: 141
European Males: 87
Indigenous Males: 583
These are from all three Algerian departments and their number is increasing daily.
Many have been held for months awaiting admission, some for more than a year
(therefore it often happens that, by the time a vacancy opens up, the patient is already
cured.) Prolonged delays also lead to the following situations:
a) Aggression from a patient hospitalized too late
b) Abuse of the patient by family members who can no longer handle the
stress of caring for them.
c) Aggravation of the preexisting condition by a delay in care
d) Minor scandals: sometimes patients with acute crises are taken to the
hospital, refused admission, and left standing at the gates often for some
time before their families return for them.
Patients imprisoned for minor offenses have even been released on medical grounds
but nevertheless kept imprisoned awaiting hospitalization. Although the Prefect has
recently demanded that the Director of the Hospital place priority on these medicolegal cases with delays for the lasting no more than a month this is only
accomplished at the detriment of subjects with more acute illnesses or requiring more
specialized care.
The mode of placement for the hospital, however, is fairly uniform: admissions
are almost always PO [ordered placement] given that only 136 of the 2101patients
admitted since September 22 were PV [voluntary placement.] Of these latter, only 15
were privately supported. However, the process for free voluntary placement consists of
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a complex administrative inquiry regarding the monetary and domestic situation of the
ill (which is never completed in less than two to three months.) Note, however, that the
number of P.V.G. [free voluntary placement] is augmented by P.O.s who could not be
accommodated and were thus reclassified as P.V.G. (allowing them to be processed and
placed on track for admission.) Finally, a particularly administrative difficulty often
arises with the admission of patients without precise identities (mostly from Morocco or
the southern provinces.) These X or S.N.P. [without family name] are thus recognized by
an admission number and photograph.
Hospitalization
With the Hospitals pavilions being inextensible, smaller spaces have to be
brought into use with massive overcrowding almost double the regulation capacity at
Blida. For instance, a ward for tubercular patients, constructed for 32, now houses 74
[end p. 1108];
a ward for the agitated, constructed for 44, now houses 106; a ward for difficult
patients, constructed for 80, now houses 165, and so on .... Thus a hospital which (at the
time of construction) was built to house 971 patients, now houses over 2000. Almost all
of the dining halls, even washrooms, have been converted into dormitories and thus, by
extension, one can clearly see dining halls which are no longer usable and what
therapeutic activity can one hope to realize in a ward containing 170 beds?
For 14 years, the doctors of Blida have asked the Administration to co nstruct
workshops or lounges. The Chapel, constructed 20 years ago, is not only used for
worship (with a priest visiting once a month) but is also used as an ergotherapy
workshop, a nursing classroom, a movie theater and such. Similarly, whereas the Mufti
108

conducts prayers there twice a month, the Mosque otherwise serves as a wicker and
sparterie weaving workshop. In wards without the benefit of ergotherapy, many patients
have no choice but to be deposited in the courtyard after breakfast (as there is no lounge.)
There are few places there for them to sit, aside from the ground (and the heat is
especially brutal during the Algerian summer ....)
The personnel strength in the economic services has been considerably
augmented:
The Kitchen: 30 employees
Electricity: 8
Linen: 26
Painting: 19
Masonry: 19
Laundry Room: 20
Such allows the hospital to function without outside assistance. In the office, similar
numbers obtain:
26 employees
Between the economic and administrative services, one finds 280 employees.
On the contrary, however, general service installations have not been similarly
improved: the overburdened electrical installations are subject to frequent outages. These
are all the more troublesome, given that the Hospitals wards are electrically heated. An
insufficient water supply only allows water three hours a day during the summer, causing
grave inconvenience for the patients (especially in the case of the incontinent.)
However, the medical services are quite satisfactory. All demands are met in a
timely fashion and the Oversight Commission has practically never had to discuss an
investigation into the Hospitals management. The medical staff is significant, and thus
we arrive at the official numbers: 1 staff person for every 15 patients in calmer wards, 1
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to 10 in wards serving the agitated. In total, then, the number of medical staff at the
Blida Psychiatric Hospital is approximately 820. Further, since this year, a nursing
school has been established. 120 current staff members enrolled and have already taken
the qualifying examination (as of this past December.) With recruitment in (at times)
difficult conditions, there often is, alas, a situation where many staff members are either
illiterate or only able to sign their names. Fortunately (as we like to say) their goodwill is
not lacking and every time a extra effort is required, they respond with perfect
spontaneity to our appeal. Although deprived from an intellectual point of view, such
staff have nevertheless been an essential resource to the wards on which they serve. All
the same, however, we must regulate the recruitment of medical staff and so currently we
now require a certificate of studies or passage of an equivalent examination.
Given that the medico-administrative sectors are increasingly cognizant of
problems concerning the hospital as a whole, measures have been adopted at the local
level which have rapidly improved the lived conditions of our patients (and, thanks to this
collaboration, others will soon be possible.) For instance, there is already a weekly
journal read by patients (which is printed by the administration.) Since the Hospital has
no auditorium, we must hold special events in the hospital pavilions and to this end the
carpenters and electricians have employed our patients in organizing the scenery, sound,
lighting, and so forth, for such events. Similarly, on the occasion of festivals observed by
the Islamic faith, traditional meals are served to our patients [end p. 1111]
Not only has the material contribution of the administrative and economic services
brought about greater interest in collective social events involving our patients but even
our director and physicians have been involved in the opening of a Moorish coffeehouse.
110

However, all of this will be difficult to continue unless the auditorium (which has been
requested by successive Hospital administrations) is not constructed and similarly with
the weekly screening of films in the chapel (a structure, character-wise and acoustically,
unsuitable for such things.)
Discharge
The problems connected with release are of particular concern especially in
regards to Muslim patients. These, already rendered difficult by certain geographic
factors, become insurmountably complex in the absence of any public or mental health
policy. Year after year, for a hospital population which never ceases to add new beds, the
number discharged from Blida has either diminished or remained stable. In the words of
a 1951 report, the Hospital is slowly but surely headed towards total asphyxiation. There
are many causes for this:
1. Patients transferred from first- line hospitals are carefully selected
according to a well-known scale of resistance to cure. Therefore, for the
first- line hospitals, H. P. B. [Blida Psychiatric Hospital] serves as a
hospice for the incurable.
2. Muslim patients, in particular, are only admitted to H. P. B. after their
illness has progressed to a shamefully advanced or even dangerous state.
3. Muslims are reluctant to entrust their women to the care of the Hospital.
If the above weigh heavily on the therapeutic possibilities, the following serve to impede
the release of patients (even when such is otherwise possible):
1. Islamic law which permits instantaneous divorce and remarriage is a
source of insurmountable difficulties. After repudiation, women even
when cured must remain hospitalized for months before they can be
reintegrated with their families which (in the absence of precise
information) must be searched for without the aid of medico-social
services.
2. Release into an unfamiliar environment is doomed to failure. Given
111

that release into a Muslim environment is practically impossible, the

problem of release into a European environment poses formidable
difficulties.
3. Contact with families hundreds of kilometers away (or more) is
difficult. In the absence of all ability to locate them by medical or
paramedical means, the contacting of families is accomplished by
administrative intermediaries.
4. The hospitalization of the aged, the feeble, and stabilized epileptics is
difficult (and often doomed to failure) due to the traditionally sacred view
of madness in Algeria.
5. For Muslims, preliminary release is an impossible dream without an
infrastructure for the provision of psychiatric care, the ability to track the
progress of social re-adaptation, or even to provide direction to the patient
(when necessary.)
6. These difficulties are multiplied nearly two and threefold in the case of
patients coming from the departments of Oran and Constantine. There is
no way for them to return to the Hospital which, geographically speaking,
is a better place for them to resolve problems connected with release.
As early as 1940, in a report to Prefect Gaubert, Professor Sutter requested (from the
Administration) the provision of:
1. Dispensaries for the preventative and post-hospitalization psychiatric
care.
2. A social service annex for H. P. B.
3. A semblance of social assistance for patients after hospitalization.
4. A society to aid former patients of H. P. B. (both newly released and
relapsed.)
Only in 1954 have we even seen the first semblance of an effort to address these
concerns.
The Psychiatric Annexes
There are two psychiatric annexes to the Blida Psychiatric Hospital, one in
Aumale (120 km from Blida), the other in Orleansville (180 km from Blida.) The
112

pressing necessity of demand, and the progressive co ngestion of H. P. B. with patients

who have not show evidence of incurability, have rendered this rather easy and facile
solution possible (in the absence of construction adapted for therapeutic activities.)
Distributed in rudimentary fashion to the general hospitals of the aforementioned areas
(which they have nearly absorbed) [end p. 1112],
these annexes are directly responsible to the center in Blida (more than 3 hours away.)
The clinical directors of Blida are required to visit the annexes once a month wherein, in
the absence of other physicians or residents, they are required to take total responsibility
for the operation of the annexes. Practically speaking, then, for the remainder of the year
the annexes are left to former section chiefs of H. P. B. who direct them with local
personnel having very brief psychiatric training.
After the Orleansville earthquake [which occurred around 11:59pm on September
8, 1954], the 200 patients of that annex were evacuated to Blida (where some are housed
in tents.) In order to assure these patients a real shelter before the winter, the Director of
Health for the Government-General plans to subdivide the several new annexes from the
civil hospitals in the region (while awaiting the construction of the Oran and Consta ntine
Psychiatric Hospitals ....) We fear that the construction of the latter will wait a long time
indeed, especially for financial reasons.
Finally, there are certain administrative features which distinguish the Blida
Psychiatric Hospital from its metropolitan counterparts. For example: (1) the Hospitals
director is chosen from the ranks of civil hospitals. Their lack of the status and
specialization of directors at metropolitan psychiatric hospitals is an inconvenience.
Even if we can congratulate ourselves on the competence of the current director, we
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should be concerned about the period of transition and adaptation which will inevitably
occur with each new director. (2) In the case of the annual leave of the director, or in the
case of his absence, the administrative service is not entrusted to one of the clinical
directors but to the treasurer. (3) The clinical director of each ward must also serve on
various boards and commissions. Experience has shown that these anomalies are not
without major inconvenience, therefore we are resolved that this hospital should resemble
a metropolitan hospital as nearly possible (in matters of administration.)
Conclusions
This study has shown that our local conditions in Algerian cannot be termed
satisfactory for the practice of psychiatry (much less the infrastructure of psychiatric
care in the three Algerian departments):
At the local level it is hoped that the Administration will finally take our
complaints (expressed for more than a decade) serio usly and give more
importance to the psychiatric hospital within the medical infrastructure in general.
We wish to see the completion of this infrastructure, hence the reduction in
overcrowding at H. P. B., and so the restoration of efficiency to that institution.
At the general level, the creation of dispensaries and post- hospitalization
services is urgently needed.
Above all, psychiatric hospitals of sufficient capacity and rational conception
must be constructed in Oran and Constantine. By all indication, the key to the problem
lies here and this, physicians have repeated for some time. Although certainly the
difficulties and resistances faced by the Administration (especially at the local level)
cannot be ignored, it seems to us that the situation has b ecome to grave for us to remain
content with remote and partial solutions.

114

The T. A. T. Amongst Muslim Wome n: Sociology of Perce ption and Imagination

Messrs. F. Fanon and C. Geronimi (of Blida-Joinville)
[1956]
The T.A.T. projective test consists in submitting to the subject a series of
situations, of perceptive panoramas, within which spontaneous lines of force emerge
(permitting a restructuring, by the self, of their field.) The polymorphism of formal
contents, the progressive complexity of situations, the rich and diverse possible
identifications permit the appearance of ambiguous signifiers (at the level of
interpretation.) Published work on the T.A.T. is quite rare, without the same measure of
bibliographical abundance as, for example, the Rorschach. Therefore, at the International
Congress of Psychiatry in 1950, Guera paid particular attention to it in an extensive,
theoretical, study of the methods of projection. Although the instrumentalist perspective
is always contestable, according to Guerra, it is from that perspective which the data of
phenomenology, gestalt, and anthropology appeared for the first time. Thus it is from
this perspective, for example, that the encounter of man and his circumstances is
mentioned. In any case, according to Guerra, we should remember one thing: As a
projective test, the T.A.T. presents characteristics of origin which reflect a determinate
epoch and social structure.1 Within the limits of Western civilizations, then similar at
the technical level, yet with sometimes very specific cultural characteristics we are

A. Guerra: Le T.A.T. co mme modle des methods projectives, in Psychiatrie Clin ique, p. 56 et. seq.
Congrs International de Psychiatrie, 1950, Hermann Editeurs.
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asked to take into consideration the rhythms of life, customs, that is, social facts (when
implementing such tests.) [end p.364.]
Recently Ombrdane, in a talk given at the Royal Belgian Ethnographic Society,
returned to this question. Legitimating Gueras doctrinal position, Ombrdane
formulated a method of the T.A.T. intended for Blacks in the Belgian Congo. 2 In North
Africa we have, for our part, experienced something so notable as to be worth repeating
here. We submitted a standard T.A.T. to a somewhat large group of Muslim women in
an open service ward in the Blida Psychiatric Hospital. From this we have retained a
dozen observations. The test was submitted to mild hypochondriacs with a touch of
anxiety, with characteristics developing in the familial milieu without severe behavioral
disturbances, and to a case of juvenile mania (who was subsequently cured without
relapse.) 3 What general attitudes did we retrieve? How did the Muslim women react to
the T.A.T.? What did the test consist in? How did the women understand it?
Amongst European women, perception was totally and immediately satisfied with this
test. They identified with the images on the cards. The Muslim women, however,
adopted a radically different attitude it was seen by them as a patient, laborious,
tenacious, effort at decipherment, at analysis.
For example:
Card 3 BM (obs. 4.)
I dont know if its a boy or a girl. I believe its a girl. I dont know
what shes doing. I dont understand. Maybe shes sick. She has a
headache [sigh], Im tired.

Ombrdane: Exploration de la mentalit des Noirs Congolais au moyen dune preuve projectif. Le
Congo T.A.T.
3
In terms of ethnicity, there were three Kabyles and nine Arabs. The median age was 23. A rural
background predominated. All were literate.
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Card 11 (obs. 7.)

[Laughter]
You say the sea, but the sea is blue and green here its black, this is
not the sea, perhaps its a village [repeatedly turning the card.] You say
an airplane, a boat, but I dont see any of these. I dont understand.
You say a serpent. You say a person [the card obviously depicts stones].
You say people, but I really cant see any. [end p. 365.]
This unique approach had transformed the test into a trial of intellectual skill. One had
the impression that the patients were set on finding the greatest number of things in the
cards. Paradoxically, however, the responses were disorganized, empty and inarticulate.
More often, we only obtained a dry enumeration. No other line opened for the women,
no other structure appeared. Narrative was non-existent. There was no scene, no drama.
They surrendered to us disordered, diverse elements collected at random from the
cards. What Dana termed perceptive organization was nowhere to be found. Despite our
precise instructions, the Muslim women did not speak of what took place, but rather of
what there was. We would equally like to call your attention to defective
identifications: for example, the violin on card 1 was described as a coffin or a
cradle; the crosses of a cemetery (on card 15) as brushes of wheatgrass or doghouses.
Plainly obvious elements like the sun on card 17 G.F., the gun on card 8 B.M., were not
seen.
At organizational level of the test, where situations of conflictual bearing, of
ambiguous attitudes of persons, generally excite the engagement of the self, all we
obtained were empty, impoverished, insignificant responses. The analysis of perceptive
modalities shows that the test was not understood, but was transformed into a test of
decoding, of reading. This intellectual, rational, pointillist, over-extended attitude is
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paradoxically understandable if we refer to the intentions of Murray. It follows from the

situation in which the patients were placed.
Asking them, in effect, to describe vividly a scene constructed by Westerners for
Westerners, we plunged them into a world different, strange, heterogeneous, nonappropriable. Their reactions are elsewhere called reactions of astonishment, of
perplexity before the unknown: My God, whats going on! The Muslim women
searched in the card for identifiable elements, but the lines of force organizing that
perception were absent: they read the cards without any lived context. One
understands, consequently, why despite an intellectual effort as important, as laborious as
theirs, we were only able to obtain disorganized responses that did not pass beyond the
stage of enumeration, of what there was. This also explains the perceptive errors and
unnoticed elements. [end p. 366.]
The absence of correlation between the perceptive stimuli offered our subjects
and the precise, exacting, and in a sense spasmed, anticipations originating from their
cultural context, account for these errors and hence the incoherent, unadapted, unclear,
inarticulate responses, and perceptions of a caricaturish bearing, signify for us that our
method was wrong. The dynamism circulating throughout Maghribi society, that is, their
cultural facts, would have to be thematized as the surrounding European world, existing
in the margins for the Muslim, induced scotomization and disinterest. The disadaptation
of our patients to this test was a consequence of the inadaptation of the test itself. The
exploration of the imagination of our patients ran squarely into analogous difficulties.
To the instructions According to you, what is happening (in this scene) and what will
happen next? we rarely obtained responses and even when we did, they were without
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psychoanalytic value. The responses, short, disorganized, were of a consistent banality.

There was not narration in them. If the T. A. T. was supposed to stimulate literary
creativity, it never fulfilled that promise with our patients. In some cases, patients even
refused to narrate. To us, they opposed an absolute ignorance: I dont know what will
happen next ... Ill only say what I know. Others justified their refusal as deriving from
Quranic requirements: I will not lie, thats a sin. Only God knows what will happen
next. From this perspective, appropriating the future amounts to substituting oneself for
God something unimaginable to a Muslim. In reality, we ought to search for what is
hidden behind this absence of imagination and refusal of fiction.
To say that the Muslim is incapable of imagining, in reference to a peculiar
genetic constitution that enters into the more general limits of primitivism, is difficult to
defend. Similarly, the explanation offered by the woman with its necessity for her to
appeal to Quranic injunctions is also an attitude beyond which it is necessary to view
these things. In reality, the previous attitude is explained by the logic of the imagination.
Imaginary life cannot be isolated from real life: the concrete, objective world, constantly
nourishes, permits, legitimates, and grounds the imaginary. Imaginary consciousness is
certainly unreal, but it is saturated with the real. Imagination, [end. p. 367.]
and the imaginary, are only possible to the extent the real belongs to us. With the T. A.
T., the card constitutes the matrix [of the imaginary.] Yet, in our analysis of the
perceptive modalities of the patients tested, we have pointed out that the card did not
furnish any schema or culturally specific patterns. There was no homogeneity between
that which one presented to the patient and that which they knew. The world that was
presented to her was unknown, strange, and odd. Faced with unusual objects,
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unidentifiable situations, rejected by panoramas hostile because of their heterogeneity,

the Muslim woman was unable to formulate an imaginary existence. The rare narratives
obtained did not reconstruct a world. In a more interesting development of the test, in the
presence of the white card, the imagination no longer encumbered by a strange cultural
yoke was able to develop. No longer stumbling over a world which excluded them, our
patients constructed rich and varied narratives.
Although sanctioned by a systematic failure, it seems to us appropriate to report
this experience. Presently, we are developing a projective test intended for Maghribi
Muslims (after cultural research is conducted.) The attempts we have undertaken
confirm our conclusion: the apparent indetermination of projective tests must be
inscribed from within a spatio-temporal context, animated by cultural dynamisms
homogeneous to the psycho-affective instances examined.

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The Maghribi Muslim Attitude Towards Madness

Frantz Fanon and Franois Sanchez
(Algiers)
[1956]
In numerous textbook chapters devoted to the history of psychiatry, the creation
of institutions for the care of mentally ill within Muslim countries is always referred to
as occurring as early as the Middle Ages at a time when such were still quite rare in the
West. For us, then, Muslim attitude towards madness assumes an importance not
negligible in the least. However, in the present work, we will confine ourselves to the
position of the Maghribi Muslim regarding madness (in light of our own experiences in
North Africa.)
It is clich to speak of the Muslim veneration of the mad, for the mentally ill (it is
said) who are in intimate contact with the mysterious world of the jinn. Supposedly,
then, the unknown elicits respect, engenders veneration. For us, however, such assertions
are not entirely accurate in regards to actual Maghribis. We will thus try to interpret such
things from the clarity of the interior, without disregarding the view the Maghribi projects
onto his world (as others have previously done.) So, then, how does the Maghribi behave
vis--vis those he considers (within his environment) to be mentally ill? Before
responding to this question, lets say a little about the Westerners attitude in such
circumstance.

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The Westerner generally believes that madness alienates the man, that one will
never understand the behaviors of the mentally ill without taking their illness into
account. However, this belief often does not entail a logical consistency as indeed it
seems the Westerner often forgets the illness. [end p.24]
The mentally ill, to him, appear complaisant with their pathology and to, more or less,
enjoy abusing those around them. In the West, then, the ill are thus somewhat
responsible for their acts and intents (as he supposedly applies himself to them.) Thus if
he is aggressive, it is not necessarily believed that this aggressiveness is entirely within
the pathological domain: it is ambiguous, in part mixed with a conscious intent to harm.
Blows are struck and followed by responses which aim not merely to restrain but also to
punish. Such patient finds himself continually immobilized, placed in a corner, not
allowed to move except have a meal or return to his bed. One is tempted to think that this
patient is a social parasite and, having chosen his way of life, would starve to death if
abandoned. Society thus comes to think of its service to the ill as a moral obligation
(exercised on their behalf.) It is not rare in the psychiatric hospital to notice such views
on the part of the staff who, with a touch of the hurtful pride of the megalomaniac,
maintain a spitefulness towards the patient which on occasion manifests itself in the
denial of a snack or of exercise. 4 The mother, unwelcomed by her son when she visits,
even leaves the hospital with bitterness in her heart. Certainly she knows very well that
her son is ill, but she does not recognize what right he has to behave in such a way
towards her, not to take into account her old age, her affection, her solicitude .
4

We remember the case of an epileptic, whose seizures were acco mpanied by rude remarks towards the
staff, having driven them to lodge a comp laint with the clinical d irector demanding that the patient be
straitjacketed for emot ionally abusing them. We also have in mind certain art icles which speak of
bloodthirsty madness, of murderous mad men, veritable filthy beasts who often take advantage of the
credulity of psychiatric examiners.
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However, if there is any established certainty, it is of what the Maghribi believes

regarding the determinism of madness: for the Maghribi, the mentally ill are absolutely
alienated. The mentally ill are not responsible for the trouble they cause: only the jinn
bears this responsibility (while the patient merely is the innocent victim of the jinn that
possesses him.) Thus it is not the patients fault if he is rude, or menacing, or persists in
total impracticality. The mother insulted or even assaulted by her mentally ill son would
never dream of accusing him of disrespect or murderous desires: she knows that her son
has no freedom, whatsoever, to intend harm. There is never any question of attributing to
him acts which he cannot will (for his will is thoroughly submitted to the influence of the
jinn.) Thus society never adopts an aggressive or suspicious attitude towards the
mentally ill and, in principle, they are never excluded from the group. But does this
mean that traditional Maghribi society makes no recourse to restraining such a patient? Is
it not advisable to restrain the jinn (if we are to use such terminology) who seems intent
on undermining the security of the patient and society at large?
As stated before, it is only the jinn who engage in such excesses (according to the
Maghribis.) The group has agreed that the intent to harm is not the patients but, instead,
only a nasty, duplicitous, game played by the malevolent jinn who possesses him. [end
p.25]
The behavior of the patient is thus interpreted according to these general beliefs. His
reputation remains intact and he is given the same esteem and social consideration as
before. The jinn-illness is merely accidental. Although durable in itself, it remains
contingent with regards to the patient: only affecting the appearance, but not the
underlying SELF. Thus there is always hope for a cure and this remains the concern of
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the group. Therefore, in the opinion of all, pilgrimages to shrines are necessary and
repeated as necessary until a cure is obtained. If the cure is not forthcoming, this leads to
pursuit of more effective therapies provided that these do not unduly exhaust the
patient. When some amelioration occurs, this is taken as indicating the course of action
is useful and should be continued (since it has already exorcised one or more jinn.) If a
cure is obtained, from that moment the patient is able to retake his place in society
(neither arousing suspicion nor ambivalence on the group.) It is possible for them to
speak of their past illness without the slightest hint of reticence. Ask a Maghribi about
his ancestors and he will, without any embarrassment, speak of every case of illness of
which he has knowledge. After all, jinn are not transmitted by way of heredity. In fact,
one may even cite cases where the duty of the husband to take his wife to a certain
marabout was written into marriage contracts (with the husband agreeing to scrupulous ly
keep the promise.)
Although certainly these observations are rudimentary and do not pretend to solve
the problem of madness in a detailed fashion merely by bringing into play individual and
familial goodwill that such concrete cases refer to, we definitively observe in the Maghrib
an articulation of beliefs harmonious with those which permit the creation and
maintenance of psychiatric services. One cannot speak of merely the returns of a
belief system merely from a quantitative point of view. Instead, in our view, the
traditional Maghribi view of therapy, resting solidly on cultural foundations, possesses a
value (on the human level) which cannot be limited solely to its effectiveness. It is
imprinted with a profoundly holistic spirit which leaves intact the image of the normal
man in spite of the existence of illness. Questions of whether illness represents
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punishment or Divine Providence are of no concern to the Maghribi, for the designs of
God are unknown to him 5 : his attitude is guided solely by respect for the person. Those
considered mentally ill are protected, nourished, and maintained by their families in the
measure possible. It is not madness which gives rise to respect, patience, or indulgence
it is the man suffering from madness (i.e., from the jinn), man qua man. Just as the
attention paid to the tubercular patient (in the West) does not imply a particular sentiment
vis--vis tuberculosis itself, neither does attention paid to the mentally (in the Maghrib)
imply sentiments regarding madness itself. For the Maghribi, one respects the mentally
ill because (in spite of it all) he remains a man; one cares for him because he is preyed
upon by powerful enemies. It is never a question of respecting the mad as such, much
less venerating them. [end p. 26.]
However, certain things must not be passed over in silence. Although this quite
rare, sometimes one does find (in certain regions or douars) certain of the mentally ill
who actually object of venerations or respect within the group (or at least a certain part
thereof.) Yet these people are not considered mad, mahboul, or possessed by jinni,
majnoun. They are considered saints and one believes in their baraka, in their beneficent
power. It is thought that their spirits are drawn close to God, majdzoub, so close that
human thought no longer inhabits their minds. Thus, regarding the question of their
mental retardation or psychoses, their fantasies or bizarrities, these troubles are in general
tolerable and compatible with their environment. 6 We know of cases of such patients
who were committed to the asylum despite the wishes of their families (who considered
them saints, exempt from all illness.) Certain families without resources will, all the
5

Mektous
Cf. E. Dermemghem Vie des Saints musulamns. Baconnier, Algiers. p.283 passim. Ed. Doutte: Les
marabouts. Lerou x, Paris, 1900. p. 77.
125
6

same, come to the hospital and demand the release of their patient always seen as a
marabout so as to gain some profit from the piety of the faithful.
Such then is definitely the Maghribi attitude towards madness. This topic is quite
important and merits further development. All the same, it is of interest to speak
(however briefly) of the way the traditional North African deals with mental illness.
Frantz Fanon and Franois Sanchez

126

The Phenome non of Agitation in the Psychiatric Milieu: General Considerations

Psychopathological Significance
by
F. Fanon and S. Asselah
Blida-Joinville Psychiatric Hospital
[1957]
Dr. Tosquelles, in a discussion in Evolution psychiatrique distinguishes two types
of agitation:
Of the expressive type, there is opposed the percepto-reactive type.
Such opposition, interesting from a heuristic perspective, in any case
didactic, seems to us quite crucial doctrinally. Likewise, the opposition of
reactive agitation or none.
In fact, except for profoundly toxic agitations which severely affect the
consciousness, agitation is nearly always expressed in the percepto-reactive mode. Or
better, compared to the typically neurological agitation of an automatic character for
instance, those made possible by violent alterations of consciousness (such as epileptic
seizures) behavioral agitation is at once expressive and percepto-reactive. Clinically,
one can distinguish (within this latter type) predominantly motor, predominantly verbal,
and verbo-motor types.
Idiots and imbeciles, on the one hand, and the senile on the other, furnish
sufficiently impressive examples of purely motor agitation which, of course, excludes the
explosive rage of the paranoid, hebrephrenic impulsion [end p. 21]
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and the circonserite agitation of the catatonic. We view agitation here only insofar as it is
a state and notice that the two poles which favor the rise of motor agitation (severe
retardation and senility) are characterized by a neurological presence. Such emp ty,
aneideic, agitations are confined to stereotypy (for instance the pseudo-anxious pacing of
the old or the shredding of clothing of the oligophrenic.) By contrast, predominantly
verbal agitation appears less neurological and hence more comprehensible. However the
incoherent soliloquy of the imbecile or the scattered verbigeration of the presbyophrenic,
in fact, strikes us by their automatic, anarchic, disintegrated, somatic character. Finally
there is verbo- motor agitation.
This latter type is perhaps the most studied, precisely because it reconstitutes the
rhythm at the basis of existent man. That is to say, speech and action combined with the
tempero-spatial structure seems to keep the organism within the realm of the
comprehensible. Again, this is perhaps why pure mania represents the most studied form
of this type of agitation. In fact, verbo- motor agitation extends far beyond the confines of
mania. Hysterical manifestations and acute phases of active delirium take on the
physiognomy of confused-enraged agitation; the anguished-ecstatic crises of Schneider,
at best, evoke only part of the manic spectrum. These mixed states had already become
so common that BERINGER had (at least from a clinical standpoint) recommended
taking a certain liberty with regard to the classical equation agitation = mania. Since
his time, there have been fortunate circumstances which now allow us to advance the idea
that agitation should be seen as a function of the hospital ward and its possibilities of
assimilation. If the hospital milieu is a therapeutic instrument, if (above all) one is
concerned with instituting a general context for disalienating encounters, if there exists
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any will to hold in ones charge a living, agitated, organism, then one poses the questio n
of an authentic discernment of the types of agitation. Only in totalitarian environments
do we find the notions of false psychosis and morbid mental persistence (or the strong
provocations of an aggressive patient and spectacular shows of force.) Such
sadomasochistic nodes easily materialize in the asylum setting and thus require our true
vigilance.
Without doubt, benevolent neutrality ought to find itself in its purity on the
hospital ward. To think the hospital as a therapeutic instrument is to structure it, to cause
it to be lived by the patient as one who finally understands rather than one who is
amputated, who is castrated. Fragmentary aggressiveness and the malicious will of the
patient directed towards the staff are quite evidently a response to a totalitarian structure
having a character that is, above all, repressive. Hence the hospital should be permeable
to the patients pathological displays, which is to say that the appearance of agitation
ought not cause the collapse of the institutional equilibrium.
Agitation thus interrogates the degree of resistance of the hospital, determining its
plasticity and solidity on such occasions. It is precisely when the agitated are not
rejected, excluded, isolated, and confined that we can endeavor to understand them. This
is not a question of merely ridding the hospital of restraints or of reversing previously
established practices for as soon as one exposes oneself to disappointment (with such
superficial measures) the restraints of ones preference return. More often than not, the
confinement of the agitated produces troublesome effects. To isolate the patient in the
interior of a hospital (in solitary confinement) is to realize a double imprisonment. The
social milieu has already rid itself of the mentally ill through demanding the passage of
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the Law of 1838, but these demands were only formal: that the exterior equilibrium ought
to be monolithic with regard to certain behaviors. Yet in many cases the hospital
environment itself has no of organization whatsoever. The lines of force which
precipitate the erection of the phenomenal field are disastrously impoverished. Excepting
the biological rhythm of three meals and then sleep, the patients day is for the most part
their own in the asylums courtyard (suggesting Brownian motion.) One soon enough
sees that restraints of a repressive character are utilized by the staff. The chain reaction:
interdiction restrain the patient doctor, this patient is running amok doctor, this
patient has injured three staff members well then, you restrain the patient, doctor!
But the fact is that the hospital itself is sadistic, repressive, rigid, asocial and manifestly
castrating, consequently it is less a question of ordering the suppression of straitjackets or
padded cells than of allowing productive lines of force, functioning at high potential in
many different areas, to circulate within the hospital.
Internment also provokes a primary disadaptation: punitive isolation (favored
moreover by the facile explanation of the staff either we isolate this violent patient or
ignore him) and the phantasms [end p. 22]
that arise out of the inevitable failure to calm the patient (which is the pseudo-concern of
the staff.) Because of isolation, of imposed solitude and thus motor constriction, new
elements arise due to the centrality of the verbo-kinetic to human existence and troubles
in the corporeal schema which arise with its disjunction. The verbo-motor agitation
caused by isolation becomes enraged, predatory, fragmentary, furious. Sometimes
delirium of hyposthenic reference isolated to outbursts of temper integrated with reality,
maintained by understandable relations with the environment are complicated by
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hallucinations: perhaps a study should be made of these provoked hallucinations. Due to

the dissolution of the organism (on the one hand) and its reaction to such (on the other), a
regression to a type of archaic thought, more dense, more dependent on mobility, less
discerning of sense data, comes into existence.
Psychoanalysis holds that oneirism, pseudo-hallucination, and the importance of
play and mimicry appear first of all during the oral stage and logorrhea, the emergence
of a whirlwind of atmospheric festivity, a being- there deployed simultaneously at two
poles of temorality, convey a staggering degree of orality yet aggressive existence,
protestation, and vehemence traverse the underlying anguish of the patient and their
infantile fantasies. However, the ease with which the agitated of the classic type
hallucinate is not really interesting (in itself) but rather the fact that the flight of ideas
prepares the way for hallucinatory phenomena (both verbal and motor.) DE
CLRAMBAULT has observed well enough those phenomena which attach mental
automatism to intuitions, anticipated thought, the echo of thought, nonsense, explosive
words, litanies of words, and syllabalic games.
With the hallucinatory process we see the collapse of the world = system of
reference. As hallucinatory time (and space as well) does not postulate even the pretense
of reality, it must be said (contrary to Sartre) that hallucination coincides with the brusque
annihilation of perceived reality. Hallucinatory time is perpetually in flight, the spatiotemporal context of active hallucination is without order, unreal, fictive. The
phenomenon of belief, which psychiatrists have spoken of at length, is what legitimates
the pseudo-reality of their troubles (in the eyes of the hallucinator.) Practically speaking,
isolation, restraint, the utilization of coercive methods by means of sadistic
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instrumentation, all work hand in hand with (or at the very least precipitate) this
regression to an hallucinatory state. Thought having fled, the patient is gripped in the
flux of images without any possibility of being extricated by the material and benevolent
aid of others.
To confine the patient, to isolate him, to confine him to his bed, is to create all the
conditions for the existence of hallucinatory activity. As one can readily observe, this
starting from anxiety, isolation, and the impression of psychobiological catastrophy
characteristic of nearly all mental illnesses fed the aggression of one who is rejected
and pushed aside already complicates clinical instruction on hallucination.
Hallucination is thus not merely the product of cerebral excitement or any specific
encephalic nutritional deficiency, it is rather an all- inclusive behavior, a type of reaction,
an organic response. Although it is true enough that the hallucinatory response also
supposes a dissolution of organic significance, such as metabolic troubles, such cannot be
seen as definitive, which is to say that hallucination entirely escapes mechanist
explanation even despite the constant citations of the work of MACFARLAND and
GOLDSTEIN of the relationship of metabolic and emotional stability, or the work of
HOSKINS on the chronic poverty of oxygen in the brain (caused by disturbances in
enzymatic catalysis) which characterizes schizophrenia. For there to be hallucination
another thing is necessary: the collapse of the real world. Regarding this, the phase at
heart of delirium to which the ancients gave the name rumination is eloquent. The
ancients held that after the period of the onset of delirium characterized by
hypochondria, worry, uncustomary corporeal manifestations, and unfamiliar visceral
sensations there occurs a phase of anxious rumination, of exacerbated concentration on
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ideas, interpretive suspicion, and aggressive solitud e: today we call this phase the prehallucinatory period.
In reality, the rejection of the real world is made possible by by the emergence of
a pseudo-world based in new relations and significations. Such solemn decision to reject
the real world needs constant validation, confirmation, and nurturing. Thus it is precisely
the ambulatory patients who never arrive at the decision to set aside, to neutralize, the
existence of the surrounding world. From this perspective, isolation therefore allows for
the authorization to hallucinate.
Hospitals have a tendency to reject the agitated patient without perceiving the
[end p.23]
fundamentally reciprocal relation existing between themselves and such patients. It is
from within a human context, the hospital, that agitation appears thus agitation must be
understood dialectically, not mechanistically. However one might refuse this
interpretation, one must recognize (and admit) that agitation diminishes as a function of
the education of the staff and the disalienating character of the milieu (however
superficial.) Agitation may, thus, be seen as the gangrene of the asylum. As
PARCHAPPE has stated:
... experience on a large scale, of many years, has demonstrated permanent
confinement to a cell, far from affecting appeasement in the mentally ill,
has to the contrary had the effect of augmenting and maintaining it.
When the hospital is a milieu of ambiguous social relations, agitation loses its resonance
of entity, of irresponsibility, of incomprehensibility. From a dialectical perspective,
agitation then reenter the primordial cycle of mirror reflection: one gives to me I
receive, I assimilate, I transform, I give back. Although certainly the catastrophic reaction
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of which agitation is only one form does not disappear, its significance is restored by
these tentative, holistic, explanations. In short, we believe that the second internment
represented by isolation should be discarded.
As far as the hospital, it must transform itself in a lucid, conscious, manner
(through a smoothing and purifying of things.) This notion of rigorous competency,
flexible staff, articulate institutions, from the start, break the vicious circle of agitation
whenever it instills itself within the patient. Whereas there was once imitation of self and
auto-intoxication, now there is a framework of open institutions. It is this engagement
with the institution itself which liberates the consciousness from instability.
It remains that the pathological reality and its symptoms confront the institution,
however organizing the hospital is not a question of curing the hebrephrenic or
hyposthenic paranoia by a game of emotional-affective investments. Indeed, the
maintaining of excitement within the hospital by means of forced stimulation tires
everyone. JANET in his Mdications Psychologiques has particularly insisted on the
injuriousness of such means. Instead, evidence of a well-organized hospital is to be
found in diminishing and residual rolls, or as EY puts it, the withering awa y of the
organo-clinic. The bringing this withering away to its minutest proportion is the primary
task of the hospital its pre- and para-therapeutic task.
The necessity of organizing the hospital, of institutionalizing it, though made
possible by social means, ought not provoke mystifications of their bases in external
reference such as:
The hospital- village
The hospital, as reflection of the external world
In the hospital as outside, the patient ought to be himself ...
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One suspects that such expressions are tentative and mask realities under falsely
psychotherapeutic humanitarian concerns and LE GUILLANT has many reasons to
condemn such attitudes as unreal. Further, if the hospital is the external world, the
tendency to legitimate that world, for it to establish systems of equilibrium like those on
the outside, will also be very strong. The prison house of medicine will suddenly
reappear with the suppression of flexibility by the clinical director, the fear of
transporting a violent patient, or the cleaning of the incontinent.
Agitation is a stranger to the institution, but so are the ill. As the hospital ought to
permit reconciliation between the real and its manifestations, it should thus never reject
the patient. Outside of the hospital, all doors are closed to the patient. Hence the hospital
is the last resort of both the social group which seeks to rid itself of the mentally ill and of
the patient who seeks to find his lost signification. Consequently, it is never a question of
only of calming agitation and the ordering prescriptions, by telephone, of Sdol and
Largactil testifies to a lack of understanding of such pathological mechanisms as
agitation. Agitation is not merely an excrescence or psycho- motor cancer if nothing
else, it is a mode of existence, a type of actualization, an expressive style.
Agitation disarms, for it is that which reunites structures. It can appear at all
levels of dissolution, yet is sufficient in itself to provoke catastrophe. Thus the agitatedwho-knows-what-he-does is rejoined in his cell by the agitated-who-knows-not-whathe-does. In reality, the agitated at the same time both knows and does not know
what he does; or better, he does not know but tries to know. These are preliminary
observations intended to clarify the discussion somewhat and hopefully they will leave
the observer with an impression disagreeable to any form of mystification. Thus
135

similarly, from the foundation of disordered, anarchic, behaviors marked as nonsense, the
fundamental ambiguity of existence is holistically assumed.

136

Day-Hospitalization in Psychiatry:
Its Value and Limits
by Dr. F. Fanon
Tunis Center for Day-Neurposychiatry
[1959]
I
GENERAL INTRODUCTION
Since the Second World War, the problems of psychiatric care have been posed
acutely to specialists in many nations. Even before 1939, priority had been placed on
both preventative care that is, the diagnosis of mental illness in its earliest stages and
on simplifying the administrative formalities surrounding the hospitalization of the ill.
The 1938 law adopted in France, to cite one example, was aimed precisely at removing
the carceral character from asylums. However, during the War, the reemergence and
(above all) blossoming forth of new mental illnesses led Anglo-Saxon physicians to
intensify the practice of open-door psychiatric hospitals. This open-door formula,
inaugurated by DUNCAN MACMILLAN in Nottingham (and taken up since then in
many other nations) permits patients to freely develop within the hospital authorizing
the maximum of contact between the patient and their environment: for instance, parental
visits, leaves of absence, vacations, early release and probationary release.

137

Although the first patients to benefit from the open-door were neurotics and
pre-psychotics, studies of chronic patients have shown that (over the longterm) the
majority of their symptoms were in fact of the neurotic type. Paradoxically, it was the
asylum which aggravated such symptoms and favored the onset of psychosis. Thus it
was only a matter of time before the principle of the day-hospital was inaugurated
(with the most conclusive results being documented in England, Denmark, and Canada.)
Hence the question: what are the principles of day-hospitalization?
1. First of all, the patient must never break with his familial milieu (nor even
with his professional milieu either.)
2. Secondly, psychiatric symptomatology does not disappear merely because
of internment, since the elements of conflict (that is, their conflictual
configuration) remain present and are rooted precisely in the familial,
social, and professional contexts.
One cannot simply make tension disappear, as the formula of internment would have us
believe, but one can always study the reactions of the patient to their natural environment.
With previous psychiatric hospitals, the patient would be removed from the
conflictual environment and one would quite often have the impression that their neurotic
symptoms would disappear as soon as the doors shut behind him. Yet the neurotic
attitudes remain and one aids in their abreaction the less the wife or husband is
permitted to visit and the less the patient is allowed to speak of past difficulties. The
asylum, intended as a protective mantle for the patient, only gave a false protection since
it merely favored their lethargy and slumber within the asylum walls (arousing a
vegetative existence.) More often than not, only the behavioral troubles of the patient
attracted the attention of the physician troubles derived precisely from the conditions of
the asylum. [end, p.689]
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Attempts made by physicians to create a neo-society within the hospital (that is,
experiments in sociotherapy) sought precisely to avoid this by imposing situations similar
to the external world upon the patient. Within such conditions, the patient would be able
to re-adapt neurotic behaviors which had previously gone untouched.
Day-hospitalization, then, responds to two pressing needs (previously
unaddressed in earlier psychiatric hospitals):

Preventative diagnosis and treatment of behavioral issues

Maintaining the maximum of contact between the patient and the external
environment (where conflictual situations do not magically d isappear.)

It is not merely a matter of isolating the patient from social life but, rather, of making
therapy available within that context. From the perspective of psychiatric care, dayhospitalization is an attempt to dissolve the atmosphere of apparent security that gives the
asylum its existence. However, day-hospitalization is rare at the most, there are only
twenty day-hospitals in the entire world (each in technologically advanced nations) and
there has never been any attempt at day-hospitalization in an underdeveloped nation.
Thus it becomes important, from a methodological point of view to ask two things: first,
whether day-hospitalization is possible in a nation with hardly any industry; secondly, if
so, can day-hospitalization respond to all psychiatric conditions. With the second, the
question of doctrine is posed. Hence we greatly appreciate the Tunisian governments
decision to create a Center for Day-Neurpsychiatry at the Charles-Nicolle Hospital in
Tunis, the only one on the African continent. [end, p. 690]
The results of that experiment will be examined below. We shall defend the validity of
the principle of day-hospitalization within underdeveloped nations and our conviction
that it is both medically and socially beneficial to develop Centers for Day139

Neuropsychiatry in such nations. As we shall see, in 18 months the Tunis Center for
Day-Neuropsychiatry has received and treated more than 1000 patients: less than 0.88%
of these have been scheduled for permanent hospitalization.
THE TUNIS CENTER FOR DAY-NEUROPSYCHIATRY
Within the Charles-Nicolle General Hospital, there existed a neuropsychiatric
ward created more than forty years ago. Practically speaking, this ward was governed by
the Law of 1838 the only difference was the relative priority given to voluntary patients
able to be released from the open service. Such measures, however, did nothing to
prevent the emergence of psychiatric hospital cells of the worst kind: straitjackets,
solitary confinement, bars, locked doors and, most of all, the complacent, punitive,
attitude of the institution. After independence, the ministerial services developed a plan
for reorganizing psychiatric assistance in Tunisia. Having stated (unanimously) their
desire not to create more of the grand psychiatric hospitals which all (sooner or later)
transform themselves into asylums, they insisted rather on attaching neuropsychiatric
wards of low capacity to general hospitals already in existence (where therapeutic
efficacy could be rationally studied and augmented.) Thus, as the total reorganization of
the Charles-Nicolle Hospital was being implemented, it was proposed that the experiment
of transforming the neurposychiatric ward of that hospital into a day-service be attempted
immediately.
Architecturally modifications were minimal: primarily making handles for doors,
removing bars, and regulating the use of restraints (such as straitjackets and handcuffs.)
A team of patients was charged with demolishing the solitary confinement units. The
building was repainted and the day-hospital capacity was fixed at 80 beds: 40 male, 40
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female. In the womens unit, a small cubicle with 6 beds was reserved for children.
However, the problem of personnel was posed.
The previous staff had grown accustomed to certain habits where repression
dominated. As is the case in a great number of present-day asylums, the patients were
considered a source of annoyance and unpleasantness. Typically, one would witness the
inversion [end, p.691]
of the formula that the patients were the final end of the hospital instead, for the staff,
the patients were the enemies of quietude. Let us point out, however, that this critique is
not specific to the Charles-Nicolle staff: one of the main criticisms of the asylum
conception has been, precisely, of the sadomasochistic relations that progressively install
themselves between the patients and staff. Nevertheless, the staff (5 women, 6 men) soon
found itself under scrutiny. Courses were promptly implemented, aimed modifying old
behaviors and attitudes in accordance to our new conception of the hospital. Soon
enough, it appeared that certain nurses were unwilling to make the effort to adapt to our
new policies and so with the agreement of the physicians they were transferred and
replaced by a younger, better educated staff who had (most importantly) never been in
contact with psychiatric patients (and thus had no prejudices regarding them.)
A DAY AT THE CENTER
At the Center, the day begins with patients arrive at around 7:00hrs (e ither alone
or accompanied by family.) On their arrival, the nurses (already in place) welcome them.
Each nurse is responsible for 6 to 8 patients and, as yet, no patient has requested a
different nurse. The session begins with the nurse giving the patient a routine physical
examination. This followed by an interview whereby information is gathered as to the
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patients sleep habits, marital relations (if married), nightmares, and dreams. On the
arrival of the physician, a report is prepared. Above all, we ask our nurses to adopt a
benevolent attitude towards the patients, especially when their oneiric materials are
particularly distressing. As a rule, three days are devoted to the mens unit and three to
the womens but more often when [end, p. 693]
the physician is informed of an anxious patient or when the patients familial troubles
during the previous night have taken hold (during the session) in an unaccustomed
fashion, an immediate intervention is made.
Two types of psychotherapy are practiced at the Center:
a) Psychoanalytically inspired techniques
b) Auxiliary psychotherapies, primarily inspired by Pavlovs Second
Signal System
In the second case, this usually consists in the nurse engaging in conversation with the
patient. With both therapies, as a general rule, the nurse should avoid questioning the
family in the presence of the patient, as well as questioning them explicitly about the
behavior of the patient precisely to avoid the appearance of rudeness towards the
parents. However, if the patient is inhibited and it is not possible to obtain information
about his life outside the hospital, the parents may be questioned (but tactfully and
outside of the presence of the patient.)
Hence, after the initial physical, interviewing, and psychotherapy, lunch is served
from 11:30hrs to 12:30hrs (as in other hospitals.) The rest of the afternoon is devoted to
such collective activities as, for instance, drama therapy. With drama therapy, nurses
meet with their patients and either recount a recent event or (better) ask each patient to
recount their difficulties to the group. The reactions of the other patients to these are then
142

noted, including their projections and identifications (we will return to this later.) As
well, other activities are scheduled such as the fabrication of objects (with men) or
knitting, sewing, and ironing (with women.) One group actually began a homemaking
course wherein patients were taught childcare and the use of sewing machines. Finally,
at 17:00hrs dinner is served and patients begin to leave the Center. At 18:00hrs, the
Center closes (and is also closed on Sundays.)
PART-TIME CARE
It often happens that a patient requires day- hospitalization but his material
conditions do not allow him to leave his job or otherwise interrupt his daily activities.
This is the case, for example, with housekeepers, students, and sales representatives. In
such cases, once the initial treatment is completed, the patient is permitted to leave the
Center. Accordingly [end, p. 694]
the sort of occupational therapy which poses such problems in the asylum finds its
solution in the best possible way. Even when the patient cannot stay for a full session,
they nevertheless do not lose contact with the milieu of their praxis or risk (thereby)
degrading their professional techniques. In fact, it would not seem utopic in the least to
address (at a later stage) a problem which now seems quite significant: the organization
of nightly sessions (after 18:00, as in those already existing in other nations.) This would
thereby allow patients in particularly difficult situations (such as functionaries, teachers,
and artisans) to receive treatment without interrupting their lives in any way whatsoever.
*
* *

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As we have previously stated, the Tunis Center for Day-Neuropsychiatry opened

its doors in May of 1958. From the month of May to the month of December of that
year, 345 patients were admitted and distributed as follows[end, p. 696]:
202 Men
135 Women
8 Children (4 boys, 4 girls)
This averages to around 57.5 patients per month. If one follows the curve of the average
stay in our facility (fig. I) one will notice that in the first month the average was 53 days
a figure which has not been surpassed (in December, for instance, this average had fallen
to 26 days.) Such figures clearly show a progressive improvement in the organization of
the service.
Men were, by far, the most numerous patients and the small number of children
can be attributed to the fact that we had originally intended to concentrate on the adult
population. It was only gradually that we have been able to install [end, p. 697]
a childrens cubicle. However, after 1959, children were admitted in significant numbers.
Demographically one finds that, of the 345 patients hospitalized at the CNPJ during its
first six months, there were 12 Jews (6 men, 6 women), 9 Europeans (8 men, 1 woman),
28 Algerian refugees (20 men, 8 women), and 296 Tunisians.
Average age of patients:
A survey of the diagram (fig. II) shows that the majority of patients were between
the ages of 15 and 35 (amongst men) and with a peak between 20 and 25 (amongst
women.) We find this interesting, since it indicates that mental illnesses arise precisely
during the period considered by Internists to be the o ne least exposed to physical illness.
However, psychiatrists find this period to be that of the expansion of the individual
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during which one chooses a profession, makes a home and raises a family. Also, this
graph indicates a remarkable rarety of mental illness during the post-menopausal period
(as well as a quasi-absence of senility.)
Familial situation:
Accounting for whether the patients were single, married, married with children,
or married without children, certain observations can be made. For instance, out of the
345 patients, 162 were in fact single (115 men, 47 women) and married patients with
children were more numerous than those without married with children constituting 105
patients (54 men, 51 women); married without just 28 (14 men, 14 women.) As one can
easily see, the 115 single men are of marriageable age but are either without work or are
paid a salary too low to be able to maintain a household (fig. III.) Similarly, those
married with children find that their material conditions cause extreme conditions which
render the raising of children a burdensome task.
The economic situation of male patients: (fig. IV)
Of the 202 men hospitalized during the first six months of the Centers operation,
petit artisans (that is, weavers, candy sellers, traveling bean salesmen, etc.) [end, p. 699]
numbered 41 and the unemployed numbered 39, comprising the two peaks on the graph.
These figures corroborate a constant within the problem of mental illness: uncertainty
about the future and material negligence favor the onset of troubles in the individual
equilibrium (from which the harmonious insertion of the individual within the group is
derived.) It is not unseasonable to note, as well, the presence of 20 Algerian refugees.
We will later see that in 1959 their numbers will be considerably augmented.

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The economic situation of female patients:

Very few of the women hospitalized at the CNPJ worked. Of the 135 total, only 4
were regularly employed (2 housekeepers, 2 working from home.) Amongst the 65
married women [end, p. 701]
(with children and without), the majority was constituted by the wives of day- laborers or
the unemployed (fig. V.)
Geographic situation:
195 patients originated from the city of Tunis, 53 from the suburbs, and 51 from
the bidonvilles (Djebel Lhamar: 16, Ras Tabia: 6, Melassine, Sada-Manoubia: 21, La
Cagna: 3, La Borgel: 5.) (fig. VI.) Sometimes patients living in the other Governates
return to live with their parents in Tunis: in this category, one finds 46. However, it
would be interesting to know whether the 195 patients from Tunis were born in Tunis or
found themselves there after a certain period of time, if they lived there permanently or
episodically, if they came to work or to settle? Such precision was difficult to obtain
initially and we plan to readdress this question at later date.
Diagnostic:
Contrary to popular belief, psychoses (including schizophrenia, chronic
hallucinatory psychoses, manias, depression, and paranoia) are not the exception at the
CNPJ. In fact one finds 129 psychoses other than schizophrenia and 34 schizophrenics
out of 337 patients. Psychoneuroses, conversion neuroses, anxious hysterias, obsessional
neuroses, sexual perversions, etc., in total only figured in at 74 cases but notice the
relatively elevated number of epileptics (at 47) (fig. IV and VII.)
1959
146

During the 11 months of 1959, 670 patients were admitted to the CNPJ. The
progressive reduction in the average stay has not relented (hence we find that for
November the average stay was an exceptional 15 days.) The proportions were similar to
those of 1958: 232 women to 322 men. However, note the greater number of children in
1959: 116 (69 boys, 47 girls.) Children are often referred to us from the educational or
familial milieu because of infantile encephalopathies, lagging behind intellectually,
stuttering, bed-wetting, and so forth. (fig. VIII.)
Average age:
In 1959, we find the same characteristics regarding the age of patients: mental
illness appears between the ages of 20 and 35. The saying [end, p. 702]
that the more one ages, the less one can suffer ought perhaps be put differently: the
more one ages, the less one does suffers. (fig. IX.)
Familial situation:
Again, in 1959, we similarly found 274 single patients and 213 who were married
with children. Those who were married without children, widow or widowers, and
divorces constituted a minute fraction of the Center s population. (fig. X.)
Economic situation of male patients:
An important element of this diagram is the number of Algerian refugees (95),
more than a sixth of the population. The pathologies of refugees, so polyvalent and
always serious, will be addressed in a forthcoming work [end, p. 704.]
As for the other rubrics, we should note the higher number of children and, naturally, the
important place of the unemployed and the small trades. (fig. XI.)

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Economic situation of female patients:

One can say that most women generally do not work. O nly widows and divorces
work for obvious reasons. On the other hand, the wives of the unemployed represent
the greatest number of women hospitalized. (fig. XII.)
Geographic situation:
As should be expected, the majority of those hospitalized at Center reside in
Tunis. Note, however, that (contrary to popular belief) patients residing in Tunis itself are
more numerous than those residing in the bidonvilles. In 1959, again, the great number
of Algerian refugees suffering from mental illness [end, p. 705]
should be noted as it surpasses those of Tunisians living in every Governate outside of
Tunis itself (95 to 93.) (fig. VI.)
Diagnostic:
We observe always a high number of psychoneuroses and psychoses. In 1959,
however, notice (as well) the appearance of numerous infantile encephalopathies and
neurological cases at the Center. (fig. XI and XIII.)
THERAPEUTIC ACTIVITIES OF THE CENTER
A)

INSULIN THERAPY

During the course of the last 17 months, 171 patients have been treated by insulin
therapy: 84 pre-comas (that is, by insulin shock therapy), 87 Sakel cures [end, p. 706]
(that is, insulin coma therapy.) On average, these patients have each had either 45 comas
or 35 insulin shocks. However, as a practical matter, insulin therapy in the day-hospital
poses serious difficulties.
For instance, the physician must be very vigilant from the beginning, as often
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patients forget to fast before treatment leading to insulin resistance (even when
significant doses are administered.) [end, p. 707]
Sometimes it only occurs to the patient to fast after the insulin dose is already elevated.
Such cases, which are easily foreseen, require particular vigilance on the part of
personnel charged with administering this therapy. If administered correctly, the patient
should regain consciousness with enough lucidity to leave the Center, unaided, at the
appointed time (and return to his residence.)
Another problem which poses itself is that of the patient slipping into a coma after
leaving the hospital. On the whole such incidents have been rare and always minor: four
in 1958 and one during the eleven months of 1959. Explanations having been previously
given to the parents, in each case, almost never did the parents have to request a
physician. Afterwards, sugar is administered to the patient by the family. [end, p. 708]
One rather grave incident a case of cerebral edema was encountered in 1958,
requiring the patient to stay overnight at the Center.
The specter of Ramadan during the course of which patients risk staying up
quite late and accumulating such sugar reserves as to make hypoglycemic coma
practically impossible remains one of our greatest fears (as far as this therapy.)
However, we recognize that the emotional and affective investments connected with this
festival (for our patients) more than compensate us for any inconvenience (as far as
administering this treatment.) Note equally that awakened agitated patients, so typical
within the psychiatric hospital setting (with their forceful unleashing of aggression), have
never been observed at the Center. In fact, it is not an exaggeration to say that our insulin
therapy patients have always (with few exceptions) left the center (as scheduled) at
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17:30hrs. [end, p. 709]

It is thus not the abandonment of the personality to the hospital that we seek but, rather,
the constant care of the patients for themselves therefore the lethargic, dull, obtuse, and
slackened patients, so typical of insulin therapy within asylum practice, are also not
encountered with day-hospitalization.
B)

SLEEP AND RELAXATION THERAPY

In each of our wards, there are five chambers where the sleep cure is
administered. Upon arrival, the patient is served a copious meal (totaling more than 1200
calories.) Once the meal is finished, the patient takes his medication and is, in principle,
allowed to sleep until 16:30hrs (which is to say that the sleep cure extends from 8:30hrs
to 16:30hrs with a 15 minute break at 12:30hrs.) From 16:30hrs to 17:30hrs, we return to
the patient and reawaken him. Finally a variable dose of neuroleptics is given to him for
the night (when he returns home.) [end, p. 710]
Once or twice a month, immediately after the meal and before the commencement of
therapy, the patient is interviewed by a physician. Altogether this treatment lasts from
two to three months. In less severe cases, a relaxation cure aided primarily by
neuroleptics is prescribed. The same principles are observed and the duration of the
treatment is practically the same as with sleep therapy.
C)

NEUROLOGY

As the Charles-Nicolle Hospital does not possess a neurology ward, all patients
affected by neurological conditions are treated at the Center for Day-Neuropsychology.
These include patients suffering from multiple sclerosis, tertiary syphilis, and brain
tumors. Of particular interest is the fact that we have performed more than 70
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pneumoencephalographies at the Center: this method has been utilized equally with men,
women, and children with all patients able to leave the facility in the afternoon (and
return the following day.) Since we are able to perform pneumoencephalographies, then
clearly we have been able to perform a significant number of spinal taps as well. These
methods have been instrumental in diagnosing brain tumors (13, to be exact.)
D)

ELECTROCONVULSIVE THERAPY

Of the 1000 patients admitted to the Center during its first 17 months of
operation, 72 have been treated by electroconvulsive therapy. In general, we use a single
electroshock and only to reverse or cut an anxiogenic circuit in the brain which has
proven difficult to treat otherwise. The absolute mean for ECT sessions at the Center has
never exceeded three and few injuries (such as dislocated shoulders) have been reported.
E)

PSYCHOTHERAPY

The guiding principle in psychotherapeutic interventions is not to assault the selfconsciousness (at least to the extent possible.) Hence the rareness of narco-analysis or
amphetamine shock therapy in our practice (as we do not believe in the curative value of
such dissolutions of self-consciousness.) Instead, the Center is oriented towards the
retaking of self-consciousness by the patient through verbalization, explication, and
reinforcement of the self.
For instance, with drama therapy a story is recounted, or a patient tells of his
difficulties, and the rest of the group is invited to give their advice regarding the situation
described. Quite often there is criticism, which sometimes [end, p. 711]
takes on the aspect of frenzied accusation in the case of mirror identification. Although
this would bring to mind sociodrama, the difference is that we endeavor to avoid fictive
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situations. Priority is thus given to biographies, as exposed by their interest in the

situations described during the drama therapy sessions. This exposure, in the course of
which the patients display, comment upon, and account for their responses to conflict, in
turn, provokes the taking of positions, criticisms, and reservations on the part of the
listeners. Correlatively, then, the patient giving the account attempts to justify himself
through his own means reintroducing the priority of reason over fantastic and
imaginary attitudes.
As well, we also utilize psychoanalytic methods at the Center. Here we apply it
to the usual problems addressed: hysteric anxiety, neurotic depression, sexual troubles
(for instance, impotence, vaginismus, or homosexuality.) Patients do not pay their
analyst and thus the neurosis of transfer is particularly atypical. However, we often
intervene in order to activate the countertransferential dyna mic. The cadence is always
the same: daily sessions (except on Sundays) the duration of which is 40 minutes.
The Tunis Center for Day-Neuropsychiatry, created 16 months ago, is the only
institution of its kind on the African continent. Having only an 80 bed capacity, it has
admitted more than 1000 patients and less than 1% have been referred to the La
Manouba Psychiatric Hospital. Although the majority of patients have been prepsychotic, we have observed a relatively high number of authentic psychoses. Finally,
not a single incident of medical or medico- legal malpractice has been reported at the
Center.

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Day-Hospitalization in Psychiatry:
Its Value and Limits
by F. Fanon and C. Geronimi
[1959]
Part Two: Doctrinal Considerations
THE TUNIS CENTER FOR DAY-NEUROPSYCHIATRY (CNPJ)
In the history of psychiatry, the doctrine of care for the mentally ill the
conception of mental illness in both its causality and dynamism has evolved even as it
has perfected our knowledge of mental illness. In the beginning, care for the mentally ill
was seen as protective: protection of society from the patient by internment, protection of
the patient from himself by the asylum which offered a soothing, self-contained
environment where a life without drama or crises could develop (a calmer, but less
socialized, life.) Subsequently, care for the mentally ill was seen as therapeutic and
preventative with the modernization of legislation, the introduction of biologicallybased methods, the creation of open services, and the increase in the number of
dispensaries. What remains, finally, is a method of psychotherapy and care for the
mentally ill begun only a few years ago which appeared sufficiently promising for us
to begin experiments with it in Tunisia: the day- hospitalization method inaugurated by
the Anglo-Saxon school. Hence the Tunis Center for Day-Neuropsychiatry was created
as the outpatient facility of the Charles-Nicolle General Hospital.
Again, patients make their way to the facility every morning beginning at 7:00hrs,
receive their scheduled treatment, and return to their domicile around 18 :00hrs. Two
characteristics its attachment to a general hospital and its method of hospitalization
153

distinguish the Tunis Center from other psychiatric facilities. Regarding the first, we
think it fundamentally necessary that psychiatric wards be attached to general hospitals,
both from our own doctrinal perspective and in recognition of the radically biological and
physiological turn in current studies of the nervous system.
The psychiatrist is no longer the alienated alienist of the prehistory of [end, p.
713]
psychiatry. Instead, the psychiatrist benefits from benefits both from the material
infrastructure of the general hospital (radiological units, biochemical and pathology
laboratories), and frequent contact with his colleagues in surgery and internal medicine,
in the practice of his specialty. Conversely, because the psychiatrist is no longer shut up
in the asylum with his madmen, he ceases to assume the air of the fantastic, mysterious,
and (on the whole) disquieting character of the alienist in the eyes of his colleagues. In
the eyes of the patient and we cannot stress this enough the psychiatrist working in
the general hospital remains a physician like the rest (thus removing much of the drama
associated with psychiatric hospitalization.) As well, the reintroduction of the
psychiatrist into medicine effectively corrects the generally well- entrenched prejudices
towards mental illness within the general public (transforming the madman into a
patient like the rest.)
Nevertheless, the primary aspect of day- hospitalization consists in the total liberty
given to the patient spectacularly breaking away from the relative (and sometimes
absolute) coercion of which clothes internment. Although (it is true) that liberty is
offered within the formula of the open service, the question is that of the formal liberty of
the patient and, even within the open service formula, physicians have often succumbed
154

to the temptation to oppose the release of a manifestly ill patient, unable to cope with
hospitalization and demanding release, from their care. However, our experience
confirms to us with every passing day that day-hospitalization for the mentally ill,
with the possibility of returning to their parents, loved ones, and world of relations each
evening, is more readily accepted by the patient than complete internment. All roads thus
return to the self-consciousness of the patient in psychiatry.
Internment signifies that the patient must, more or less, unilaterally disarm and
rely on us, that resistance is futile, that he literally requires our tutelage and protection.
Day-hospitalization, on the contrary, is offered to sustain passage, to momentarily
reinforce the personality: it is a prolonged visit. The physician-patient relation is thus
normalized. [end, p. 715.]
As the patient can only actualize their release through the benevolence of the physician,
the dialect of master and slave, prisoner and jailer (from which internment or the menace
of internment derives) is radically rejected to the extent possible. Thus the physicianpatient encounter within the context of day-hospitalization remains a permanent
encounter of two- liberties an encounter which is necessary for any form of therapy
(psychiatry most of all.)
Conversely, if we phenomenologically bracket out gross alterations of the
consciousness, mental illness actually presents itself as a pathology of freedom. Illness
situates the patient in a world where his liberty, will, and desires are constantly broken by
obsessions, inhibitions, contraindications, and anxiety. Typical hospitalization forbids
the patient all compensation and displacement, restrains him to the close quarters of t he
hospital, and condemns him to exercise his liberty in an unreal world of phantasms. Thus
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it is not surprising that the patient, typically, only feels free in opposition to the physician.
And as every psychiatrist knows, the hardest patients to treat are those who (from the
start of their illness) believed they were well enough to leave the hospital. It is therefore
precisely the least psychologically disorganized patients the neurotics, petit-paranoics,
and those with minor delirium who are least likely to accept to accept full
hospitalization. On the contrary, those with an inactive self-consciousness, completely
overrun by delirium or who otherwise need our permanent care, respond poorly to dayhospitalization. However, and always according to the needs of the patients, dayhospitalization also reveals its unique characteristics.
For instance, in the typical psychiatric hospital, therapeutic activity never extends
beyond 16:00hrs. Once medications are distributed, and afternoon group therapy
sessions have ended, patients are abandoned to themselves. This abandonment is
particularly felt in the evening after the final inspection and at the moment when the
nurses (sometimes already in civilian dress) pass their instructions on to the night
watchman. Yet, exterior life nevertheless infiltrates the hospital though the plans and
projects of the staff: movie nights, evenings with loved-ones, rendezvous at the caf
which all take on an accrued depth in the eyes of the patient (who remains confined in the
silence and boredom of the hospital room.) Already distressing for the patient
immobilized by a fracture, typhoid, or heart failure, this abandonment becomes an
occasion for contestation and revolt against the hospital several times a day with the
psychiatric patient (who literally feels immobilized only by the coercion of the hospital.)
It was to diminish such tension, and to maintain the patient in a certain degree of
sociability, that sociotherapy was attempted. [end, p. 717]
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The creation of a neo-society within the hospital (with a multiplicity of ties,

duties, and the possibility for the patient to assume roles and responsibilities) constituted,
without doubt, a decisive turn in the comprehension of madness and we have already
employed it to great effect in Blida. Within the context of the new society established by
sociotherapy, one aids in the transformation of the old symptomatology found in the
asylum namely, the purely desocialized state increasingly overtaken by the morbid
sphere of stereotypy, hallucinatory agitation, catatonia and such. To the contrary, with
sociotherapy the patient is required to speak, to explain themselves, to take a position.
An investment is thus maintained in an objective world that, with sociotherapy, has
acquired a new depth. Sociotherapy thus detaches the patient from their phantasms and
obliges them to confront reality on a new register. Although the new state initially
remains pathological as it is often developed at an imaginary and symbolic level o n the
part of the patient) the physician may still effectively study the dynamics of treatment
and the mechanisms of projection and identification (and thus attend to and observe the
self in its efforts to maintain its already regressed unity.)
However, it must be admitted that with sociotherapy we create fixed institutions
with strict, rigid, boundaries and a rapidly stereotyped schemata. Within the neo-society,
there is no imagination (neither creative dynamism nor innovation.) The institution
remains the cadaveric cement spoken of by Mauss. Sociotherapy remains far from
useless, however: within large aggregates such as Blida (with nearly 1000 patients) or the
Razi Hospital (with nearly 1300), sociotherapy effectively combats the progressive
disintegration of the personality in such settings. In the asylum, sociotherapy is
indispensable as it has the advantage of conserving the socialization of the patients and
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hence actively avoiding chroniciszation (which constitutes both the rot of the asylum and
decay of the patient), but it rarely cures. Sociotherapy reactivates the delirant and
hallucinatory processes, provokes new dramatizations, and permits the physician to better
understand what has outwardly taken place, yet the inert character of this pseudosociety, its strictly specialized limits, the restricted number of mechanisms and the lived
internment/imprisonment of the patient (precisely what it seeks to hide) considerably
limit the curative and disalienating value of sociotherapy. [end, p. 718]
Thus, today, we affirm that the true sociotherapeutic milieu is (and remains) concrete
society itself.
THE PATIENT AND ILLNESS IN DAY-HOSPITALIZATION
At the level of professional relations, a patient hospitalized at the center is similar
to a worker on holiday. In practice, the patient returns to their domicile at the same time
they would normally (for instance, when the factory or workshop would close.) As
before, he encounters his workplace colleagues on the bus (or the suburban train) who are
also on their way home. Such encounters are productive for the patient as, once the
patient has been hospitalized, the appeal of the professional milieu always shows itself
much stronger than the negative value it had acquired before hospitalization. The life of
the workplace and proximity to coworkers, once seen as dangerous, progressively loses
its traumatic character. Instead of a web in which liberty is perpetually snared, the
professional milieu becomes the location where liberty is exercised and deepened.
Again, it is clear why the French School (with Ey) has defined madness as a pathology of
freedom.

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The patient who leaves the Center reclaims his automatisms at the door. He will
continue his periodic rendezvous at the caf, evening prayers at the mosque, or
participation in his political cell. After 18:00hrs, then, the patient is once again placed
into the complex game of socio-personal coordinates (which, in turn, delimits his
insertion into world such as his bi-weekly card game or, again, his political cell.) The
mother equally remains in constant relation to her space of activity. On the way home
from treatment she will travel, in turn, to the grocer, the butcher, and the newsstand. She
continues to occupy her place in the home (which now pre sents itself as temporarily,
rather than fundamentally, disordered.) On Sundays, family gatherings are held and
outings to the countryside follow; cinema, theater, and sporting events continue to inform
the personality (and thereby promote the growth of affective reactions, options, and
dynamic relations.) Thus one sees that society is not cut off. The therapist, thus is not
confronted with the excluded or isolated patient to the contrary, he is confronted with a
personality in which relations remain alive and active. The patient continues to be
impregnated by society, the family, and the professional milieu. Once again, the patient
never loses contact with the world. By contrast, it is well known that in many psychiatric
facilities the patient is legally deprived of visits for five years and confined to a pavilion
under the observation of a psychiatrist. [end, p. 721]
In the day-hospital, the psychiatrist has before him an illness living through the
patient, a personality in crisis in the midst of an ever-changing environment. Psychiatry
thus becomes the concrete, dynamic study, en vivo, of illness. The ambivalence of the
patient and their illness is thus not only a troubled affectivity in abstracto, isolated as
symptoms of a delirium or through the course of conversation it is a manifest,
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perceptible, ambivalence which tears apart the synthetic unity of man and his
environment (on a daily basis.) The symptomatology reveals itself dialectically and it is
dialectically that the psychiatrist must think and act (regarding it.) The descriptive
semiology so capital to the asylum period now takes second place: the approach is
existential instead of nosological. We view the patient living in his illness, developing
reactional formations, inhibitions, and identifications in their natural context. It is from a
point of departure in the self that we are able to dynamically understand the causal
structures of illness the impoverishment of the self and the assaults upon the personality
that our patients must face. In brief, it is through taking pathological existence as our
point of departure that we decide on the place and type of our activity: what we decide
dialectically includes all the elements of the situation (as opposed to a pointilist approach
to different symptoms.) Ours is an absolute attack upon a structure, a form of existence
and a personality engaged in ever-shifting conflicts.
Although some psychiatric hospitals, allow patient to keep his clothing, necktie,
or shirt and others allow him to keep his electric razor, money, or his wedding ring
with day-hospitalization, that problem is reversed. The institution, in fact, never takes
hold of the liberty of the patient (or even of his immediate appearance.) With the
patients initial confrontation with the institution, the forms of existence and their
contents (rather than forms of being) are progressively challenged. A patient hospitalized
at the CNPJ may indeed shave himself everyday in his own kitchen or bathroom with his
own razor, choose his own necktie, climb a precipice, walk the streets, stroll around a
lake and so on; a woman hospitalized here might indeed bathe, brush her teeth, and put
on her makeup in her own home environment. The fact of taking life into their own
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hands through dressing themselves, cutting their own hair and, above all, taking the
secrets of that part of their life spent outside of the hospital into their own hands,
reinforces (and in every case maintains) the patients personality as opposed to the
psychologically dissolvent integration into the psychiatric hospital (which paves the way
towards fantasies of bodily dissolution or the crumbling away of the self.) Indeed, both
Melanie Klein and Sandor Ferenczi (among others) have shown us the importance of this
cultivation of ones own body as a mechanism for avoiding anxiety. Internment shatters
the narcissism of the patient, crucifies it in its attempts at hedonism, and carries it (in
traumatist fashion) [end, p. 723]
down the way of regression, danger, and anxiety.
From another perspective, day-hospitalization permits us to analyze the particular
attitude of the family group with regard to the patient and his illness. With standard
psychiatric hospitals, there has been a strong tendency for the family to disengage, to
exclude the patient. Although certainly the rejection is aimed more at the pathology than
at the patient, the patient nevertheless lives this as authentic condemnation of his essence,
of his truth. In rejecting the pathology, in demarcating itself from the patient, the family
declares that it no longer recognizes the excrescence which the patient is thus seen as.
The family chooses not to know one of its own members, interns him, and the familial
unity is shattered hence the piercing question that endures throughout mental illness,
addressed to us by the mentally ill at multiple levels and according to different registers:
In reality, who am I? Yet is this not a question fundamental to all subjectivity?
Therefore, if the family decides to signify to the patient that they no longer identify with
him, that they recognize him no more, that they participate in a fundamentally different
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essence from his, how many disintegrations are possible and how many bridges to
phantasm and regression do they offer him?
By contrast, day- hospitalization permits the family to prolong its battle for unity.
It offers to the family a means of avoiding the amputation of one of its members
allowing the patient to remain within the familial body and thereby occupy his place as a
dynamic element within that family unit (a pole of activities and carrier of significations.)
Day-hospitalization permits the therapist to test the family in its normative capacity
while, at the same time, the therapist sustains himself through daily contact with the
family (where truly all mediation is located.) Thus the dizzying phenomena of release,
spectacular relapses, and difficulties of readaptation are avoided, since the therapy is
developed precisely through taking account of the multi- relational reality of the patients
(who never break with their milieu.)
THE PRESENCE OF CONFLICT
Day-hospitalization both presupposes and clarifies a general theory of the
dynamics of mental illness. Even though it is admitted that the psychiatric symptom
testifies to the submersion of the self by abnormally vehement instinctual forces, or else
are manifestations of a hopelessly conflictual existence, there still is a strong tendency to
remove the patient from the causal or active active elements of conflict The [end, p.
725.]
pathogenic character of conflict is privileged. With internment, one witnesses the
objectification of conflict (namely, as the patient.) In erecting the wall of the asylum
between the patient and the external conditions, those who argue that the patient is the
source of conflict propose to magically negate one of the most essential facts of the
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genesis of the personality: however, they cannot for long negate that conflict is the
conclusion of an uninterrupted dialectic between the subject and the world by merely
(and systematically) focusing on the event while minimizing history. This is not merely a
matter of biography or remembering but of the history of the subject in all that it contains
on the level of successive integrations, conflicts, and the elements of their dissolution.
Although internment diminishes the violence of conflict the noxious reality
the patients brain will not regain its health by denying that reality. It is only at the heart
of the faint dialogue between the whole personality and their environment that a cure, the
placing into question prescribed for established pathological structures, can be affected.
Action upon the real, and upon the patient as an element of the real, are thus unified and
this unity usefully cannot develop on a diffused order. In the psychiatric hospital,
however, there is no interaction with the environment and we remain indefinitely at the
magical level (where the patient wishes for his illnesss disappearance, and watches for
the attenuation of his symptoms while such symptoms remain misunderstood, scandalous,
and strange.)
Some will ask Isnt this day-hospitalization you describe not really
psychotherapy in private practice? Isnt this simply a form of o ut-patient therapy? To
this we respond firmly in the negative. The patient indeed maintains limited contact with
conflictual elements, however the therapist controls the action of this conflict
interposing the barrier of daily hospitalization between pathogenic messages and
phantasmic substrates. The duration of the conflict is diminished and the self is
reinforced in view of imminent and daily affronts. Hospitalized patients have always
been cared for beforehand, whether as clients or by various neuropsychiatric dispensaries.
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With day-hospitalization, the neurotic nucleus is attacked on the existential level and the
personality, at the same time, affects its own restructuring (bringing itself to light.)
THE TUNIS CENTER
Our experiment in Tunis has confirmed these theoretical considerations and has
also permitted us to specify the limits of effective day-hospitalization. The Tunis Center
for Day-Neuropsychiatry was created nearly two years ago. More than 1200 patients
have been hospitalized during that period. The Center is divided into two sections (40
male, 40 female) and admits all nosological categories (from speech impediments [end, p.
727]
to erotomaniac delirium including schizophrenia and attempted suicides.) The absence
of a neurological ward at the Charles-Nicolle Hospital placed upon us the obligation of
admitting neurological cases as well: patients in the early stages of multiple sclerosis,
with severe seizures of undetermined cause, and aggravated or uncontrolled
Parkinsonism were all referred to the CNPJ. Whenever tumoral processes were
suspected, a pneumoencephalography would be taken. Nearly 70
pneumoencephalographies were performed, either when tumors were suspected or where
pneumotherapy seemed necessary: twenty tumors were diagnosed by this method and a
case of pantophobic anxiety (as well as a secondary delirium associated with dementia)
was spectacularly cured. Of these patients (who received 100 to 150ccs of air during
these treatments), all left the hospital tranquilly at around 17:00hrs and not a single
complication has been reported.
Schizophrenics admitted to the Center (the majority being paranoid
schizophrenics) are usually treated with the classic Sakel cure. Not merely insulin shock,
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but veritable comas (sometimes to the 5th degree of the South American scale) have been
reached. Treatment begins, according to a regular schedule, at 7:30hrs and the patient is
revived at 12:00hrs. Afterwards, the patient remains under medical supervision while
participating in collective activities or individual sessions with a therapist.

That

evening, the patient returns to his family and they receive necessary instructions in case
of a relapse into insulin coma. If all else fails, a telephone number is given to the
patients family in case of grave events. Thus, of the 100 patients treated by insulin
therapy, only one (an insulin resistant schizophrenic) relapsed into a coma both times
he was revived without complication.
Different forms of psychotherapy are also applied at the CNPJ. We particularly
favor group psychotherapy, thus we have formed groups of 6 to 8 patients who meet with
a nurse every afternoon. Each patient is asked to tell the others of his difficulties while
the others, in turn, are asked to give their opinions regarding the attitude adopted by the
patient. Thus each patient is studied always starting with concrete situations then
progressing to the different mechanisms of projection, identification and so forth. [end, p.
729]
Aside from group therapy, individual psychotherapy is also practiced ranging from
banal supportive psychotherapy to the psychoanalytic cure (employing the entire
spectrum of psychoanalytically inspired techniques.) Our psychoanalytic technique seeks
to be a calming one in which we particularly encourage the reconstruction of fantasies on
the part of the patient and the adoption of an active attitude (in the sense of Ferenczi) on
the part of the therapist.

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Although day-hospitalization is a remarkably effective therapeutic instrument,

there are cases where it reveals itself as inapplicable or inappropriate. For instance, in
cases where the organic component of the illness is massive, dominant, and poses serious
therapeutic problems: above all, this is the case with acute psychoses, manic or
confusional, which require real therapeutic urgency and constant medical attention.
However, thanks to advances in chemiotherapy, the total hospital stay (for such cases)
can be considerably reduced and the patient transferred to day-hospitalization in as short
a time as possible. As well, the acute outbursts which mark the onset of grave psychoses
like schizophrenia; delirium tremens, with its biological component that escapes the
confines of subjectivity (and hence day-hospitalization); and organic dementias are also
beyond the scope of day-hospitalization. Finally, patients with an active delirium
entailing dangerously aggressive behavior , that is to say, medico- legal cases who are
better referred to the police, also fall outside the jurisdiction of day-hospitalization. All
of the above sectors of psychiatry, quite important in themselves and furnishing a
significant portion of psychiatric hospital clientele, escape the limits of dayhospitalization. Aside from the problem of dementia, however (which, despite all effort,
still only admits of asylum care), we can say that the other cases (excluded above) might
also conceivably be treated by means of day-hospitalization (once their acute symptoms
subside.)
However, another problem presents itself to day-hospitalization: that of patients
who live very far from the hospital and are thus not able to leave and return on a daily
basis indicating both an economic and a physiological misery which would prevent this
treatment because of the journey it entails. Thus, if we would increase the number of
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psychiatric (or neuropsychiatric) wards in general hospitals and this should be our
objective in the struggle against mental illness we must find a solution which alleviates
all the inconveniences of day-hospitalization while conserving its ideals. [end, p. 731]
Many possible accommodations already exist today. For example, local asylums might
be transformed into psychiatric wards which would welcome acute patients for limited
stays. One might also imagine a formula where a number of beds are reserved for dayhospitalization while others are reserved for longterm care. In that case, the provision of
strict legislation is advised (in order to prevent day- hospitalization from being
transformed into a banal open service): for instance, limiting longterm hospitalization to
patients residing in areas geographically distant from the hospital and restricting the inhospital duration of acute patients. These are only a few examples, and one might easily
imagine more, however one thing is certain: we would like to avoid, at all costs, the
creation of monstrosities like the classical psychiatric hospitals.
CONCLUSION
Our experiment in Tunisia, now after more than 20 months, has permitted us to
verify the soundness of the theoretical foundations of day-hospitalization in psychiatry.
On the both therapeutic and preventative levels, the CNPJ at the Charles-Nicolle Hospital
has furnished proof of its efficacy. The high number of patients treated (more than
1200), and the reduction of the median stay to 25 days, are quite eloquent and speak for
themselves.
As well, our experience shows that this technique, originating in areas of high
economic development, is able to be transplanted to less economically de veloped areas
without losing any of its value. Day-hospitalization is, by far, the form of psychiatric
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care most adequate to the treatment of mental illness (being better able to adapt to
modern discoveries on the etiology of mental disorders.) Psychiatric wards in general
hospitals and within these, the most significant function being reserved for dayhospitalization ought to form the basis for all psychiatric services (in any country.)
Whatever rare psychiatric hospitals are constructed should be done so on the condition of
being reserved for those categories of patients who cannot be treated in hospital
psychiatric wards (whether open service or day- hospital.) In all cases, such hospitals
should be of limited number and reduced capacity (more than a 200 bed capacity would
seem, to us, absurd.) Finally, very strict legislation should be passed guaranteeing the
maximum liberty of the patient and hence retiring all carceral and coercive aspects of
internment.

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The Encounter of Society and Psychiatry

(Lecture Notes, Tunis, 1959-1960)
Frantz Fanon
The mad are strangers to society and society seeks to rid itself of such
anarchic elements. Internment is the rejection, the pushing aside of the ill, yet society
demands that psychiatrists renders them once again fit to re-enter society. The
psychiatrist is the auxiliary of the police, the protector of society against ....
The social group seeks to protect itself and shuts away the ill. Thus, when the
patient leaves the institution without the agreement of the physician this has immediate
consequences. Psychiatrists have thus reacted violently against this role, demanding that
authorities allow a certain measure of spontaneity between the patient and their family.
This new perspective has born fruit. We will see much later how in practicing selfplacement the mentally ill are able to become conscious of their illness.
The problem of the consciousness of illness poses dilemmas. Is there no method
for certifying if a mental illness has disappeared? At what moment can we say that the ill
are cured?
Since 1930, sociologists have furnished psychiatry with many interesting
questions. For instance, since effectively the patient has lost sense of the soc ial, we must
resocialize them for certain, the socialized can live without speaking of him. Only, to
which group ought we readapt him? Notice that it is possible to be re-admitted to the
familial group yet, only with difficulty, to the work environment (or vice versa.) We see
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sexual perverts who are successful according to societal standards. Among

schizophrenics, in the catatonic form, there is indeed a withdrawal from society and
there are moral masochists. Are these people abnormal? Is the purpose of man to never
pose problems for the group? One might say, therefore, that the normal man is he who
does not make trouble. But, then, are trade unionists on strike normal?
What is the criterion of normality? Certainly work is the criterion but the
prostitute works, and maybe it is precisely because she is neurotic. Similarly, what about
the unemployed are they ill? Many of the unemployed become ill, but is it because
they are simply unemployed? [end. p. 2.]
The physician is placed between society and the ill. For example, through
correspondence with society, the physician determines what is to be done for the patient
and society endeavors to control the practice of psychiatry. The patient often seems
cured, yet relapses sometimes gravely (e.g., those contemplating suicide) hence the
effort to create a society within the walls of the hospital. That is, sociotherapy.
Before sociotherapy, life [in the psychiatric hospital] was unorganized: divided
into quarters, chambers, and cells. The essential instrument was the key. At the basis of
sociotherapy are certain principles:
1. Madness is forbidden in the hospital: Before, when the patient would scream,
one would merely say that they were only fulfilling their function as mad.
Now all pathological manifestations are to be stopped the reason of the
patient ought to be opposed to their unreason. With practice, this experience
is extremely rich for the patient. One cannot be mad with a sane brain, with
clean neural connections. Across these connections, the way is opened
through which the physician must enter with new principles (wherever
madness is permitted.)
2. Modification of daily rhythm: The privileged trajectories of the patients were
formerly arranged into categories. Now we impose upon them a rhythm. We
create dining rooms, replace forks and napkins, and ask that patients exhibit
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normal attitudes in such setting. The patient must work and be compensated.
Patients must participate in activities and meetings in the presence of a doctor.
The problem of group tolerance regarding the patient is of the utmost
importance.
Difficulties of sociotherapy: the tolerance with regards to the patient may derive from
extensive material abuse: Anglo-American hospitals are like jailhouses staffed by a rural
constabulary. Some even say sociotherapy creates a false community, but can we really
domesticate the social environment into the natural? [end p. 3.]
Socialization in the function of cerebral matter.
We now abandon the classical sociological perspective in favor o f
neurophysiology. The bipedal position stands the body upright, tilts the head forward,
models the face and augments the cranial capacity: this hominization we retain

Increasing complexity of the nervous system and of the brain, which reaches its
final phase in the human brain (with its exaggerated development of
hemispheres.)

two sorts of integration: subcortical integration (amongst many animals in which

the cerebral cortex is less developed), the cerebral cortex (in Man.) Subcortical
integration gives way to the cerebral cortex. The human brain is not only larger,
but also more complex, than most animals. The maximum amount of neurons
accompanies the maximum number of faculties. There are exist many bundles of
associations no point in the brain, e.g., is tied directly to all others.

How does the brain function? It comprises of nothing more than the most ordinary
animal protoplasm (phenomena of polarization and depolarization.)* Is the human brain
give once and for all? Is the child born with a brain which develops as a function of
endogenous phenomena (the thesis of CUVIER) or is the brain a social product
(originating out of essentially nothing), as suggested by LAMARCKs thesis.
There is also hemispheric dominance: one finds the center of language in the left
hemisphere (as children with right-sided hemiplegia can speak.) However, when the left
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hemisphere is affected, there is an inversion and the right brain takes the place of the left.
The deaf are not born mute. Since there is no physical connection between the two
phenomena, the connection must derive from the progressive abandonment of natural
speech movements. Hence, one becomes mute because one is deaf. [end p. 4.]
The human brain has enormous potentials, but these potentials must develop within a
coherent environment. Messages delivered to the brain must be received.
The power to be socialized entails, from the beginning, having a normally
constituted brain. But this is a question of a necessary condition with others intervening.
Piaget accords a great importance to language, but before language there is another
preliminary stage. At the cerebral level, there is consubstantiality between the self and
others. Thus one can say that the small child is egocentric and does not see the external
world. Otto Rank has described his famous trauma of birth, however (in the practice of
natural childbirth), one realizes that birth is a physiological (not a pathological) act. Our
view (of the innateness of egocentrism) is supported by a number of examples:
1 A baby of six months is unable to sleep without light: it must always sleep
with the lights on (light has an intoxicating effect on brain cells.)
2 A baby of three months, with dermatitis resists all attempts to treat it: its
mother suckles the child as if it were a repulsive object.
3 A baby two and a half months old does not sleep or eat and even when it
does eat, continues to lose weight. Its parents are insomniacs. Entrusted to its
grandmother, the baby recovers and returns to a normal sleep pattern.
4 A baby of fourteen months does not sleep and is aggressive: the father was
unemployed and beat his wife.
5 A baby of fourteen months vomits uncontrollably: this is due to the parents
attitude towards the child the father doubts its paternity.
6 A child doesnt smile: the mother has dual facial paralysis.
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From its first weeks stereotypes appear. There is a constant presence of the social
environment. Even from the first months of life, the child is gripped by the social milieu.
[end p. 5.]
If certain children speak late, this is generally because of a need to lift inhibitions which
were installed during early childhood. The case of dyslexia requires special attention.
The Formation of the Self
The neurological view agrees with the psychoanalytic view that, at the time of the
latency phase, all is placed in order. According to Lacan, the newborn is fragmented
(i.e., associations have not been established.) At six months, this mutates into a
recognition of the mothers image by the child and the certainty acquired by the child that
the other is equal to me. Lacan calls this the mirror stage: if one places the child before
a mirror at four months, nothing happens; but at six months there is extraordinary
jubilation a recognition that he ties to the maternal image. The thing I call me is
haunted by the existence of the other. For man, the mirror stage is a usual state the
child reacts to the human image very early (as a conditioned reflex.)
Although the brain is not constitutionally delicate, the child is quite sensitive to
modifications of the environment. To be socialized is to maintain a constant tension
between the self and society. With language this becomes even more complicated: as
words tend to become symbols of symbols. If the environment does not authorize me to
respond, it is clear I will atrophy, that I will be stopped, arrested, that I will not have a
normal rhythm. If the environment imprisons me, there is conflic t a perspective the
functional complexity of the brain is not open to. To be socialized, then, is to respond to
the social environment, to accept that the social environment influences me.
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Control and Surveillance

One may say that modern times are characterized by the placing of men into files
(into dossiers.) Psychiatry intervenes when man becomes part [end. p. 6.]
of a schema of labor, of a profession the man working in a company, on an assembly
line, needs to be controlled. Before, one controlled the object, the work put into the
object: this was qualitative control. With the development of the marketplace, we have
the introduction of quantification. It became a question of hours of work, of the numbers
of hours one spent on the assembly line. This was the origin of the surveillance camera.
The surveillance camera has the nicknames shopkeeper or Grandpa the
employer calls it the anti-theft device. To be a good worker is to have no history with
the surveillance camera. The relations of the worker to the camera are strict, minute.
Man feels the presence of the camera as a weight. To be on time, for the worker, is to be
at peace with the camera. (The ethical notion of culpability is introduced here.)* The
camera warns of and limits the culpability endemic to the worker. For the employer, the
camera is indispensable. However, the camera because of its continual presence
introduces a number of behaviors amongst workers. These represent the complete
control of the camera upon the worker. Before the era of the surveillance camera, the
worker could excuse himself since then, the worker is constantly denied solicitude by
the impossibility of persuading the employer of his good will. Hence, the pathological
behaviors observed:

nervous tension; explosive tempers

the dreams of such workers nightmares:

A train that leaves me behind
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 A gate the locks me out

A door that does not open
A game Im not included in
The employer having disappeared, being replaced by the camera.
But it is not simply that this relationship which is reified, it is likewise the employee
himself. [end p.7.]

absenteeism: One arrives late but does not go to work for fear of being
found out but instead goes to the doctor in order to obtain a leave of
absence. But there are the controlled. But the factory worker doesnt notice
those who are lazy. He notices his boredom, the impression of being excluded
from the group, of displacement

reinforcement of obsessive attitudes: time is no longer something within

which I work in the manner ordered, it is something which I must account for.

accidents: there are 50% more accidents before work than after, even though
the worker is (nonetheless) more fatigued after work

loss of reflex control

The Neuroses of Telephone Operators

The milieu studied was central Paris. Le Huilan [Louis Le Guillant] gives us numerous
cases. Note the following phenomena:

an empty sensation in the head. Intellectual work impossible

impossibility of natural childbirth: loss of reflex control

obsessive phenomena

mood swings endured by the spouse and the family. Employees are not able
to take the noise

insomnia

somatic troubles: anorexia; constant illness; all of which affects marital life.

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From where do these troubles arise? Many calls. The need to keep the headphones on.
Le Huilan speaks of the switchboards controlled by surveillance.: the employee feels
constantly spied upon; she constantly watches [end p. 8.]
herself. The body, in all its manifestations is plagued by the hallucinatory perception of
eyes. The role of the employee consists in maintaining communication, maintaining
files, abstraction. In public services, telephone operators are not under surveillance and
their troubles are no more than those due to the mechanistic character of their profession
(as opposed to those of switchboard operators.) We have here, with (the switchboard
operators) an example of psychiatry terms the exterior action syndrome which often
leads to suicides.
Employees of Department Stores
In the United States, in particular, cameras function in department stores without
the employees knowledge. Ostensibly, this is not only to watch the employees but the
thieves as well. Yet the only ones inhibited are the employees who understand they are
constantly spied upon. Hence syndromes of the same type as the surveilled switchboard
operators. Within the technological environment, then, one tends to reduce
communication and transform man into an automaton.
The Problem of Racism (United States)
In compartmentalized societies, one observes behavior characterized by the
predominance of nervous tension which, soon enough, leads to exhaustion. Among
Black Americans, the control of the self is permanent and at all levels: emotional,
affective .... This compartment called the color bar is something rigid, its presence
piercing. When one reads the detective novels of Chester Himes (For Love of Imabelle,
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The Crazy Kill, etc ....) one sees quite well that aggression is dominant in Harlem. By a
sort of internalization, Black aggression is turned inward against the Black there is a
reprise of condemnation, the Black assumes his own condemnation. [end p. 9.]
Note the importance of feelings of guilt amongst Blacks and Jews.
One thinks the Negro merely wants to leave Harlem, but he really wishes to
turn white. Religion is often conceived of as a means of whitening. Only occasionally
does one see attempts (c.f., Green Pastures) which show that Paradise is Black, that Jesus
Christ is Black.

the theme of escape in Negro spirituals, of departure, of flight

The desire to become great, to be champion of something hence the historic

revenge of the Black American during sporting events like the Olympics.

The obsession with suicide: c.f., the Blues and (other) Black American music.
In certain of the Blues, the aggression is very clear: I pray to God that this
train going East crashes, and that the engineer is killed ....

Blacks have only resource, to kill. However, when one Black kills another, nothing
happens. When a Black kills a white, the police are mobilized.
The Problem of the Encounter
In what measure, in a society as compartmentalized as American society, is it
even possible for the Black to meet the white? When the Black faces the white, right
away stereotypes intervene. He cannot be true with the white because their systems of
value are not the same. At bottom is a falsehood, the falsehood of the situation. To
admit this is to admit that one is a member of ones social group: if the Black is
dominated, one cannot demand of him a human comportment. When the Black
addresses himself to the white, there is a particular voice, that is, a particular turn and
style. [end p. 10.]
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When the white element intervenes in Harlem, racial solidarity manifests itself
immediately.
The Problem of Psychopathology
From infancy, society intervenes in the development of the personality. In nursery
rhymes there already appears the theme of Blackness: dors, dors, mon ngro, prends
ton bon temps, parce quaprs ce nest pas drle. That is, conditioning by the absurd.
There is space reserved within such that entails prohibition. There are intense
psychological and muscular tensions that produce headaches and ulcers. Inquietude is
important. (The rejection of inferiority complexes.)* The difficulty of defending ones
love of self devalorizes self- love. At the same time, there is a delicacy, a sensitivity at
the level of the skin.
Colonized Society
In territories under foreign domination, one finds the same attitudes (as in
Harlem.) The Algerians who enlisted in the German army did so hoping for the
liberation of their country. The Manifesto of May 31, 1943 demanded the right of self
determination for the Algerians. The enormous reticence of the Algerians to fight in the
War: they said the enemies of our enemies are our friends. In 1939, when the
conviction of the Algerian people was that the Germans would triumph, they praised
Hitler. In 1942, they even formed a territorial militia. But politicians, knowing full- well
what Nazi ideology was, explained that such illusions were useless. Even in Iran and
Iraq, the pro-Nazi movements were above all anti-English or anti-French. There is a
revaluation of values with independence. When independence is acquired, there is no
longer any renown for the veteran. Aim Csaire wrote that the Europeans were anti178

Nazi because the Nazis had imposed upon Europe the same violence it had imposed on
the colonized. [end p. 11.]
Ethnopsychiatric Considerations
Ethnopsychiatry has described the dependence of the Malagasy, the indolence of
the Hindu. In 1918, a Professor of Neuropsychiatry Professor Porot of the Faculty of
Algiers published an article on the Psychiatry of the Muslim where he characterized
the Muslim by:

absence (or near absence) of emotion

credulity

tenacious persistence

a propensity for accidents and crises of hysteria

In 1932 (Annales medico-psychologiques), however, he stated that the Kabyle was

intelligent escaping the mental debility constant amongst other Algerians. In 1935,
during a related discussion, [Henri] Baruk stated that the Algerian was severely retarded
a primitive being for whom life was essentially vegetative and instinctual: with t he
slightest psychic shock, reactions were diencephalic rather than psychomotor. Professor
Sutter returned to the question: The primitivism of the Algerian is not for lack of
maturity, it is a social condition that causes the termination of his evolution. Thus one
cannot explain primitivism by reason of domination this primitivism is applied, in
logical fashion to a way of life different from ours. Sutter has said this much more
profoundly.
The work of the School of Algiers does not rest in isolatio n. Remarks of the same
genre were made by Dr. Gallet [Dr. Paul Gallais] (in Marseille) regarding the tirailleurs
179

sngalaise. Dr. Carrothers [Dr. J. C. Carothers] made a study of Kenya, on the MauMau revolt and sought to bring the notion of jealousy into play (as the British favored
certain tribes over others.) (the role of frustrated love for the father symbolized by the
British colonizer.)* The African according to Carrothers is constitutively lobotomized:
c.f., The African Mind in Health and Illness (1954.) For this work, he was invited to
present at the World Health Organization. [end p.12.]
The Relation of the Colonized to Work in the Colonized Society
To study the relations of co-operation between the colonizer, the native-born settler, and
the colonized is to reveal what is actually no relation at all.
The Colonized worker and the State: To the colonized, the state presents itself from the
beginning as a stranger. The agricultural worker in the rubber plantations of Indochina
and the miner in Southwest Africa have nothing in common with the European peasant.
The settler affirms himself by force. The metropolitan flag waves over the colonized
territory and this is a violation. With the miners of Northern France, there is
homogeneity, the same exists in the strikes made within the context of the national circle.
The colonized are able to conceive of struggle only in putting forward a radical
contesting of the domination of their country by another.
Before the arrival of the foreigner, the colonial state did not exist much less a
State of Nature.

The action of the metropole exercised itself against nature herself, and

against beings insofar as they were still in the State of Nature. Labor, insofar as it
enriched man, was the privilege of the settler only the settler worked to cultivate nature
and being at the same time. The natives and the bush, Mitidja and persistent idleness
were the same thing. All the same, he built the roads; all the same, he struggled against
180

leprosy and malaria, against the indigenous. He changed nature in spite of herself, for it
did him violence. He brutalized the native, made him good in spite of himself. When
one speaks of the gold of the Transvaal, one thinks of the persistence of the settler. But
what has this hostility realized in the native? There only inertia, abulia, stagnation, the
desire to perpetuate the current state of affairs, difficulty in acting: this is idleness. To
study work in the colonies is, in a way, to study idleness refer to Terres article on this
subject in Prsence africaine (1952.)
This notion of lack of exertion, uncooperativeness, is a constant in metropole/colony
relations. If one wants to create works, if one wants to humanize nature, one must force
this is [end p. 13.]
forced labor. Forced labor is the reply of the settler to the idleness of the native if you
want the native to work, youd better make him work. Forced labor is thus the logical
consequence of colonial society. Knowing how to force the native means knowing how
to beat him.
This idleness confronts the rapacity of the settler, his eagerness to make money.
Laziness in the lived colonial context, is the will to make such profit difficult. It is a
means of theft. The settler doesnt work from eternal devotion, but only for himself.
This is why, from the point of view of the colonial state, investments are nonsense for
to invest in the colonized region is to be confronted by its future. In the colonies, then,
private industry can find but little capital. The settler does not come to the colonies from
the perspective of determined economic development but only to amass as much profit in
the minimum amount of time.

181

If we consider the union question, we see that it is posed according to particular

themes. The unionism of the metropole is, above all, implanted with the same
watchwords as the metropole itself the same with political parties. The problem is not
posed in a heterogeneous, but in a homogeneous fashion. The labor ideology is the same
in the metropole as in the colonies. Thus unionized colonial workers are already
specialized workers or functionaries, assimils, and thus no one will find them taking
up the call for national consciousness (only the 87% of nonunionized labor which does
not pose the problem in the same way as they do. ) But eventually their taking up of
national consciousness will occur.
The Notion of Unemployment
There are no unemployed workers in the colonies, only natives whose energy
cannot be claimed by the colonial society. [end p. 14.]
These constitute a reserve in case of the defection of other workers. According to Prof.
Porot, the North African ages quite early (around 35 or 40.) Unemployment is not a
human problem, but a perpetual reserve to replace the prematurely aged, in case of
strikes, or better, to blackmail the workers into accepting prohibitively low salaries.
Massive unemployment does not bother the colonizer.
If there is no unemployment the colony, if there is professionalization, if
universities are open to all, this is no colony. Unemployment in the colony there should
be as endemic there as yellow fever or malaria but statistics show that tropical illnesses
are considerably diminished. The question is of how to introduce new relations into
society, for to introduce new relations is to deny the colonial system.

182

Is the colonized [really] lazy? The laziness of the colonized is a protection, a

measure of self-defense above all physiological. Work has been conceived of as forced
labor and, even if it were not for pointless conflicts amongst the colonized, the colonial
situation itself is a pointless conflict. Thus its normal that the colonized does not [devote
him/herself] to work, because for him work never ends. We must reclaim labor as the
humanization of man. Man, when he sets himself to work, enriches nature and himself as
well. There ought to be enriching relations of generosity for there would be the reform
of nature, a modification of nature because man has remodeled himself.
The colonized who resist have reason.

183

Notes
1

Sch mitt, Carl. The Concept of the Political. Translated by George Schwab. Chicago: Un iversity of
Chicago Press, 2007. 26-29. Hereafter, Sch mitt 2007.
2

Lo rde, Audre. Sister Outsider: Essays & Speeches. Freedo m (CA): Crossings Press, 1984. I have
borrowed this term fro m Lorde because it seems an apt description of the type of engagement with t he
other Fanon envisioned as being necessary.
3

A 19th century diagnostic princip le which stated that every illness was caused by a lesion in the tissues .

Co mte, Auguste. System of Positive Polity. volume 4. New Yo rk: Burt Franklin, 1968. 649. Hereafter,
Co mte 1968.
5

Ackerknecht, Erwin H. Broussais, or a forgotten medical revolution. Bulletin of the History of

Medicine, 1953:320-343. 322. Hereafter, Ackerknecht 1953.
6

Ibid.

Ackerknecht 1953, 328.

Ackerknecht 1953, 341.

Co mte 1968, 650.

10

Co mte 1968, 649.

11

Ackerknecht 1953, 327.

12

Ackerknecht 1953, 328-329.

13

Ackerknecht 1953, 325.

14

Goldstein, Jan. Console and Classify: The French Psychiatric Profession in the Nineteenth Century.
Cambridge: Camb ridge University Press, 1987. 253. Hereafter, Go ldstein 1987.
15

Ibid.

16

Dowb iggin, Ian R. Inheriting Madness: Professionalization and Psychiatric Knowledge in Nineteenth Century France. Berkeley : University of California Press, 1991. 69-72. Hereafter, Dowbiggin 1991.
17

Appel, Toby A. The Cuvier-Geoffroy Debate: French Biology in the Decade before Darwin . Oxfo rd:
Oxford Un iversity Press, 1987. 16. Hereafter, Appel 1987.
18

Goldstein 1987, 23.

19

Williams, Elizabeth. The Physical and the Moral: Anthropology, Physiology, and Philosophical
Medicine in France, 1750-1850. Cambridge: Cambridge Un iversity Press, 1994. 234. Hereafter,
Williams 1994.
20

Appel 1987, 17.

21

Ibid.

22

Appel 1987, 17-18.

184

23

Appel 1987, 141-142.

24

Appel 1987, 4.

25

Appel 1987, 3-4.

26

Appel 1987, 178-180.

27

Appel 1987, 180.

28

Appel 1987, 234-235.

29

Williams 1994, 234.

30

Appel 1987, 244.

31

Williams 1994, 235.

32

Williams 1994, 233-234.

33

Williams 1994, 236-237.

34

Williams 1994, 237-238.

35

Williams 1994, 238.

36

Appel 1987, 125.

37

Williams 1994, 238.

38

Williams 1994, 256.

39

Williams 1994, 256 n.39.

40

Williams 1994, 193.

41

Williams 1994, 191.

42

Williams 1994, 258-259.

43

Williams 1994, 256-263.

44

Dowb iggin 1991, 118.

45

Dowb iggin 1991, 122.

46

Dowb iggin 1991, 118.

47

Dowb iggin 1991, 73.

48

Dowb iggin 1991, 125-126.

49

Nye, Robert A. Crime, Madness, and Politics in Modern France: The Medical Conception of National
Decline. Princeton: Princeton University Press, 1984. 23. Hereafter, Nye 1984.
185

50

Harris, Ruth. Murders and Madness: Medicine, Law, and Society in the Fin de Sicle. Oxford: Oxfo rd
University Press, 1989. 126-129. Hereafter, Harris 1989.
51

Harris 1989, 129.

52

Harris 1989, 138.

53

Dowb iggin 1991, 162.

54

Harris 1989, 81-82.

55

Harris 1989, 81.

56

Gibson, Mary. Born to Crime: Cesare Lombroso and the Origins of Biological Criminology . Westport
(CT): Praeger Pub lishers, 2002. 20-21. Hereafter, Gibson 2002.
57

Ibid.

58

Gibson 2002, 99-100.

59

Nye 1984, 112.

60

Tarde, Gabriel. Penal Philosophy. Boston, 1912. xxi-xxii. Hereafter, Tarde 1912.

61

Tarde 1912, 182.

62

Tarde 1912, 326-331.

63

Tarde 1912, 180.

64

Harris 1989, 88.

65

Tarde 1912, 178.

66

Tarde 1912, 182.

67

Cherki, A lice. Frantz Fanon: A Portrait. Translated by Nadia Benabid. Ithaca: Cornell University
Press, 2006. 38. Hereafter, Cherki 2006.
68

Fanon, Frantz. A Dying Colonialism. Translated by Haakon Chevalier. New York: Grove: 1965. 45.
Hereafter Fanon 1965.
69

Lazreg, Marn ia. The Eloquence of Silence: Algerian Women in Question. New York: Routledge, 1994.
38. Hereafter, Lazreg 1994.
70
71
72

Lazreg 1994, 41-43.

Kabyles are members of an ethnic group in the Sahara region now properly known as the Imazighen.
Lazreg 1994, 49-50.

73

Keller, Richard C. Action Psychologique: French Psychiatry in Colonial North Africa, 1900-1962.
Ph.D. diss. Rutgers University, 2001. 355.
186

74

Nye 1984, 112-113.

75

Keller, Richard C. Colonial Madness: Psychiatry in French North Africa. Chicago: University of
Chicago Press, 2007. 125. Hereafter, Keller 2007.
76

Ibid.

77

Keller 2007, 78.

78

Desruelles, Maurice and Henri Bersot. Care of the insane in Algeria since the nineteenth century.
History of Psychiatry, no.7. (1996): 549-561. 349.
79

Keller 2007, 41-43.

80

Keller 2007, 126.

81

Raimundo Oda, Ana Mara, et. al. So me orig ins of cross-cultural psychiatry. History o f Psychiatry
16, no. 2 (2005): 155-169. 163.
82

Macey, David. Frantz Fanon: A Biography. New York: Picador, 2001. 221.

83

Keller 2007, 137.

84

Keller 2007, 57.

85

Keller 2007, 60.

86

Keller 2007, 57-60.

87

Macey 2001, 221.

88

Keller 2007, 60, 137.

89

Keller 2007, 130-133.

90

Cherki 2006, 63.

91

Keller 2007, 130.

92

Ibid.

93

Lvy-Bruhl, Lucien. How Natives Think . Translated by Lilian A. Clare. Princeton: Princeton Univers ity
Press, 1985.
94

Keller 2007, 133-135.

95

Keller 2007, 140.

96

Dowb iggin 1991, 120.

97

Keller 2007, 140.

98

Keller 2007, 141.

187

99

Fanon, Frantz. Toward the African Revolution. Translated by Haakon Chevalier. New York: Grove,
1967. 11-12. Hereafter, Fanon 1967a.
100

Fanon, Frantz. Black Skin, White Masks. Translated by Charles Lam Markmann. New York: Grove,
1967. 18-19. Hereafter, Fanon 1967b.
101

Dowb iggin 1991, 45.

102

Williams 1994, 154-157.

103

Williams 1994, 152.

104

Goldstein 1987, 287-291.

105

Goldstein 1987, 287.

106

Goldstein 1987, 288-289.

107

Goldstein 1987, 289.

108

Goldstein 1987, 286.

109

Goldstein 1987, 285.

110

Goldstein 1987, 291-292.

111

Goldstein 1987, 291.

112

Ibid.

113

Goldstein 1987, 292-296.

114

Goldstein 1987, 276.

115

Harris 1989, 140-141.

116

Harris 1989, 140.

117

Harris 1989, 141.

118

Marin i, Marcelle. Jacques Lacan: The French Context. Translated by Anne Tomiche. New
Brunswick: Rutgers Univeristy Press, 1992. 98. Hereafter, Marini 1992.
119

Harris 1989, 141.

120

Dowb iggin 1991, 45.

121

Harris 1989, 32.

122

Dowb iggin 1991, 120.

123

Harris 1989, 32.

124

Harris 1989, 71.

188

125

Mordier, Jean-Pierre. Les dbuts de la psychanalyse en France, 1896-1926. Paris: d itions Maspero,
1981. 189-190.
126

Keller 2007, 229.

127

Keller 2007, 228.

128

Keller 2007, 229-230.

129

Harris 1989, 141.

130

Keller 2007, 79.

131

Keller 2007, 69.

132

Keller 2007, 49.

133

Keller 2007, 50.

134

Keller 2007, 74.

135

Keller 2007, 56.

136

Ibid.

137

Keller 2007, 56-57.

138

Keller 2007, 60.

139

Thomas, Gregory M. Open psychiatric services in interwar France. History of Psychiatry, v.15, no.2.
(2004): 131-153. 148.
140

Keller 2007, 75.

141

Keller 2007, 75-76.

142

Goldstein 1987, 276.

143

Keller 2007, 41.

144

Keller 2007, 52.

145

Keller 2007, 78.

146

Keller 2007, 76.

147

Latour, Bruno. The Pasteurization of France. Translated by Alan Sheridan and John Law. Cambridge
(MA): Harvard University Press, 1988. 143-145.
148

Fanon 1967a, 6.

149

Fanon 1967, 8.

150

Williams 1994,
189

151

Fanon 1967a, 9.

152

Fanon 1967a, 10.

153

Fanon 1967a, 10-13.

154

Wynter, Sylvia. Towards the Sociogenic Princip le: Fanon, the Puzzle of Conscious Experience, of
Identity and What its Like to be Black. National Identity and Social Change: Latin America Between
Marginalization and Integration. Edited by Mercedes Durn-Cogan and Antonio G mez-Moriana. New
Yo rk: Garland, 2000.
155

Kojve, Alexandre. Introduction to the Reading of Hegel: Lectures on the Phenomenology of Spirit .
Ed ited by Allen Bloo m and Translated by James H. Nichols, Jr. Ithaca: Cornell, 1980. 36. Hereafter,
Kojve 1980.
156

Kojve 1980, 37-38.

157

Kojve 1980, 38.

158

Kojve 1980, 39.

159

Kojve 1980,41.

160

Kojve 1980, 40.

161

Kojve 1980, 40-41.

162

Kojve 1980, 14-15.

163

Kojve 1980, 19.

164

Kojve 1980,19-20.

165

Kojve 1980, 29-30.

166

Fanon 1967b, 17-18.

167

Fanon 1967b, 41-83.

168

Fanon 1967b, 98-99.

169

Fanon 1967b, 127.

170

Fanon 1967b, 124-125, 130-131.

171

Fanon 1967b, 127, 129.

172

Fanon 1967b, 132-133.

173

Fanon 1967b, 109.

174

Fanon 1967b, 112. Here I refer to the passage beginning with I existed t rip ly ....

175

Fanon 1967b, 114. Although, for Sch mitt, such admiration on the part of the wo man would not indicate
the lack of en mity, e.g., Sch mitt 2007, 27.
190

176

Fanon 1967b, 113-117.

177

Maldonado-Torres, Nelson. Against the War: Views fro m the Underside of Modernity. Du rham (NC):
Duke University Press, 2008. 122-123.
178

Du Bois, W. E. B. Writings: The Suppression of the African Slave-Trade, The Souls of Black Folk, Dusk
of Dawn, Essays and Articles. New York: Library of A merica, 1986. 363. Hereafter, Du Bo is 1986.
179

Du Bois 1986, 364.

180

Du Bois 1986, 365-368, 370.

181

Freud, Sig mund. An Outline of Psycho-Analysis. Translated by James St rachey. New Yo rk: Norton,
1948. 59.
182

Fanon 1967b, 215.

183

Fanon 1967b, 146.

184

Fanon 1967b, 147.

185

Fanon 1967b, 146-147.

186

Sch mitt 2007, 29.

187

Fanon 1967b, 154.

188

Fanon 1967b, 45-47.

189

Fanon 1967b, 65-69.

190

Sch mitt 2007, 46.

191

Sch mitt 2007, 53.

192

Fanon 1967b, 217.

193

Kojve 1980, 13. Kojve here reads Hegel as stating that the initial encounter with the other is one
characterized by a provocation of the other into battle.
194

Fanon 1967b, 231.

195

Goldstein 1987, 368.

196

Eh len 2000, 99-101.

197

Geismar, Peter. Fanon. New York: Dial Press, 1971. 52. Hereafter, Geis mar 1971.

198

Macey 2000, 148-149.

199

Macey 2000, 145-146.

200

Macey 2000, 146.

191

201

Macey 2000, 146.

202

Macey 2000, 146.

203

Razanajao, C. L., J. Postel, and D. F. A llen. The life and psychiatric work of Frantz Fanon. History
of Psychiatry, no.7 (1996): 499-524. 501. Hereafter Razanajao, Postel, and Allen 1996.
204

Bu lhan, Hussein. Frantz Fanon and the Psychology of Oppression. New Yo rk: Plenum, 1985. 32.

205

Macey 2000, 199.

206

Geismar 1971, 58-59.

207

Fanon, Frantz and Franois Sanchez. The Maghrib i Muslim Attitude Towards Madness. Revue
pratique de psychologie de la vie sociale et dhygine mentale, no. 1 (1956): 24-27. 24-25. Hereafter
Fanon and Sanchez 1956.
208

Sch mitt 2007, 38.

209

Sch mitt 2007, 46-47.

210

Fanon and Sanchez 1956, 25.

211

Fanon and Sanchez 1956, 25-26.

212

Fanon and Sanchez 1956, 26.

213

Buck v. Bell, 274 U. S. 200 (1927), 270.

214

Fanon, Frantz and Slimane Asselah. Le Phno mne de lagitation en milieu psychiatrique:
considerations gnrales signification psychopathologique. Maroc mdicale, 36 (January 1957): 21-24.
Hereafter, Fanon and Asselah 1957.
215

Fanon and Asselah 1957, 22-23.

216

Fanon and Asselah 1957, 23.

217

Fanon and Asselah 1957, 22.

218

Guattari, Flix. The Guattari Reader. Ed ited by Gary Genosko. Oxford : Blackwell, 1996. 42.
Hereafter, Guattari 1996.
219

Fanon and Asselah 1957, 24.

220

Ibid.

221

Fanon, Frantz and Charles Geronimi. LHospitalisation de jour en psychiatrie, valeur et limites. I.
Introduction gnrale; II. Considrations doctrinales. La Tunisie mdicale 47, no. 10 (1959): 689-732.
717-721. Hereafter ,Fanon and Geronimi 1959.
222

Fanon and Geronimi 1959, 718.

223

Fanon and Geronimi 1959, 693.

224

Macey 2000, 145-146.

192

225

Fanon and Geronimi 1959, 708

226

Fanon and Geronimi 1959, 729.

227

Fanon and Geronimi 1959, 707.

228

Fanon and Geronimi 1959, 709.

229

Fanon and Geronimi 1959, 710.

230

Fanon and Geronimi 1959, 711.

231

Fanon and Geronimi 1959, 725.

232

Fanon and Geronimi 1959, 696-706.

233

Fanon and Geronimi 1959, 704.

234

Fanon and Geronimi 1959, 725.

235

Fanon and Geronimi 1959, 697.

236

Fanon and Geronimi 1959, 702.

237

Fanon Frantz and Jacques Azoulay. La socialthrap ie dans un service dhommes musulmans:
difficults mthodologiqes. Information psychiatrique 30, no. 9 (1954): 1095-1106. Hereafter, Fanon
and Azoulay 1954.
238

Fanon, Frantz and Charles Geronimi. Le TAT chez le femme musulmane: sociologie de la perception
et de limagination. Comptes Rendus: Congrs des medicins alienistes et neurologistes de France et des
pays de langue franaise. Bordeau x (1956): 364-368. Hereafter, Fanon and Geron imi 1956.
239

Fanon and Azoulay 1954, 1099.

240

Gordon, Lewis R. Her Majestys Other Children: Sketches of Racism from a Neocolonial Age. Lanham
(MD): Ro wman & Litt lefield, 1997. 54-56.
241

Fanon and Azoulay 1954, 1097.

242

Fanon and Azoulay 1954, 1098,1105.

243

Fanon and Geronimi 1956, 365.

244

Fanon and Azoulay 1954, 1106.

245

Fanon and Geronimi 1956, 367.

246

Fanon 1967b, 112.

247

Fanon and Azoulay 1954, 1102.

248

Fanon and Azoulay 1954, 1105.

249

Fanon and Geronimi 1956, 368.

193

250

Fanon, Frantz and R. Lacaton. Conduites daveux en Afrique du Nord. Co mptes Rendus: Congrs
des medicins alienistes et neurologistes de France et des pays de langue franaise. Nice (1955): 657-660.
Hereafter, Fanon and Lacaton 1955.
251

Fanon and Lacaton 1955, 657.

252

Fanon anf Lacaton 1955, 658.

253

Ibid.

254

Fanon and Lacaton 1955, 659.

255

Ibid.

256

Fanon and Lacaton 1955, 660.

257

Sch mitt 2007, 46-47.

258

J. Dequeker, F. Fanon, R. Lacaton, M. Micucci, F. Rame. Aspects actuels de lassistance mentale en

Afrique du nord. In formation psychiatrique 31, no. 11 (1955): 1107-1113. 1107. Hereafter Dequeker,
et. al. 1955.
259

Cherki 2006, 61-62.

260

Dequeker, et. al. 1955, 1108.

261

Dequeker, et. al. 1955, 1111.

262

Dequeker, et. al. 1955, 1112.

263

Ibid.

264

Fanon, Frantz. The Wretched of the Earth. Translated by Constance Farrington. New Yo rk: Grove,
1963. 250. Hereafter, Fanon 1963.
265

Fanon 1963, 39.

266

Fanon 1965, 44 n8.

267

Fanon 1965, 53.

268

Fanon 1963, 249.

269

Stern, Daniel. The Interpersonal World of the Infant: A View from Psychoanalysis & Developmental
Psychology. New Yo rk: Basic Books, 2000. 101.
270

Fanon, Frantz. Rencontre de la socit et de la psychiatrie (notes de course, Tunis, 1959-60). Lilia
Bensalem, ed. Etudes et Recherches sur la psychologie en Algerie. Oran (Algeria): CRIDSSH, 1984. 5.
Hereafter, Fanon 1984.
271

Fanon 1984, 5-6.

272

Sch mitt, Carl. Political Theology: Four Chapters on the Concept of Sovereignty. Translated by George
Schwab. Ch icago: Un iversity of Chicago Press, 2005. 15.
194

273

Fanon 1984, 10.

274

Sch mitt 2007, 79.

275

Fanon 1984, 6-7.

276

Fanon 1984, 7.

277

Fanon 1984, 8-9.

278

Medicine: Veritable Annihilat ion. Ti me Magazine, Monday, May 21, 1956.

279

Fanon 1984, 7-8.

280

Cf. Fanon 1967b, 108.

281

Fanon 1984, 14.

282

Fanon 1984, 8.

283

Guattari 1996, 42.

284

Guattari 1996, 42-43.

285

Guattari 1996, 43.

286

Guattari 1996, 44.

287

Ibid.

288

Sch mitt 2007, 47.

289

Sch mitt 2007, 48.

290

Sch mitt 2007, 53.

291

Schmitt, Carl. The Crisis of Parliamentary Democracy. Translated by Ellen Kennedy. Cambridge
(MA): M IT, 1988. 14-15. Hereafter, Sch mitt 1988.
292

Sch mitt 1988, 26.

293

Fanon 1967b, 100.

294

Fanon 1963, 155.

295

Fanon 1965, 107-110.

296

Fanon 1965, 156-157.

297

Fanon 1965, 24.

298

Fanon 1963, 151-152, 168-169.

299

Fanon 1963, 156-157.

195

300

Fanon 1963, 164-165.

301

Fanon 1963, 159-163.

302

Fanon 1963, 174-175.

303

Lugones, Mara. On Co mp lex Co mmunication. Hypatia v. 21, no. 3 (2006): 75-85. 84.

304

Sch mitt, Carl. Theory of the Partisan. Translated by T. L. Ulmen. New York: Te los, 2007. 94. To be
clear, in this passage Schmitt argues against the notion of an absolute enemy.
305

Fanon 1963, 249-250.

196

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