Women of the Collective
Care and politics around Saint-Alban Psychiatric Hospital: 1930–1960
Joana MasóTRANSLATED BY PERWANA NAZIF AND JESSE NEWBERG
“Let’s not build for eternity.”
—Agnès Masson (1948b, p. 32)
From the 1930s to the 1960s, experimental practices, at once political, psychiatric and artistic, flourished at the Saint-Alban-sur-Limagnole asylum in Lozère. According to legend, a group of men—communist doctors, militants, thinkers, writers, artists, or art theorists affiliated with surrealism—transformed collective life from within the psychiatric institution. However, it was the invention of new relations to work and culture that ultimately made the humanization of care possible. On the one hand, spaces for ergotherapy, or work therapy, and social therapy more broadly, enabled experiments in socialization and the emergence of a cooperative economy, self-managed by the hospital patients.[1] On the other, cultural practices were supported: cinema and amateur theater, writing and singing, as well as the planning of parties and the opportunity for residents to create objects, sculptures, drawings, and paintings, many of which Jean Debuffet would later appropriate after World War II under the name of “art brut” (Tosquelles 1952).
Exiled Catalan psychiatrist François Tosquelles worked at Saint-Alban’s hospital between 1940 and 1962. It is with his arrival that the story of Saint Alban
begins to be written. Almost immediately, a vast project of institutional transformation and collective work was implemented in collaboration with the psychiatrists Paul Balvet, Lucien Bonnafé, and André Chaurand of the Society de Gévaudan, an informal collective organized around the discussion of “the practical work of observing patients” in an “interdisciplinary” approach combining psychoanalysis and intellectual work (Koenig 2021, p. 110) or psychiatry and the avant-garde (Mabin 2015); “a circle open to heterogeneous contributions” (Tosquelles 1952, p. 537). It was a question then of the “delimitation and definition of psychiatry” as well as the urgency of “unmasking ‘false problems’”: “madness is not a personal affair,” but “a historical and dialectical phenomenon” (Balvet, Bonnafé, Chaurand, Clément et Rivoire 2014, p. 235–246).
During the Occupation, visitors to the hospital and Society of Gévaudan participants included philosopher, physician, and historian of science Georges Canguilhem who stayed for almost two weeks in 1943; between November 1943 and February 1944, the poet Paul Éluard, active in the Resistance, was visited by film historian Georges Sadoul and photographer Jacques Matarasso. After the Liberation, artist Jean Dubuffet briefly visited the hospital in the summer of 1945; while Dadaist poet Tristan Tzara and Surrealist painter Gérard Vulliamy stayed with Dr. Lucien Bonnafé. Psychiatrist and founder of La Borde clinic, Jean Oury interned at Saint-Alban between 1947 and 1949; as did psychiatrist, writer, and decolonial thinker Frantz Fanon from April 1952 to August 1953. Psychoanalyst and philosopher Félix Guattari stayed there in 1957. Novelist Hervé Bazin paid a visit in 1959. Documentary filmmaker and writer Mario Ruspoli shot three films there in 1961.
From Fanon to Ruspoli, from Oury to Guattari, Saint-Alban marked the inauguration in France of what psychiatrists Georges Daumézon and Philippe Koechlin, in 1952, would name institutional psychotherapy. With a conception of the asylum as a “liv- ing being” “homogenous with society” (Balvet et al. 1946, p. 14), allowing the “excavation of non-alienated capacities in every patient: reciprocity, responsibility and dignity” (Bonnafé 1943), institutional psychotherapy set out to cure the psychiatric institution itself in order to treat the patients. For Daumézon and Koechlin (1952), “in this perspective, totally foreign to that of the asylum, conventional relationships are overturned in favor of the common pursuit of a new, universally recognized goal. The participation of staff and patients in this undertaking must be free, independent of any hope of ‘reward’ or risk of sanction, so that relationships are no longer determined by the traditional logic of the asylum.” This psychotherapy of the institution “is the work of an entire team, among whom we note: Balvet in Lyon, Bernard in Lommelet, Bonnafé in Saint-Alban and Rouen, Chaurand in Saint-Alban, Daumézon in Fleury-les-Aubrais, Le Guillant in Ville- juif, Sivadon and Follin in Ville-Evrard. The source of inspiration for most of them was Tosquelles in Saint-Alban.”
In this mythical story of the transformation of asylums, the presence of these big names has often overshadowed both the hospital as a place of collective life and care as well as the work of the women who shaped its new contours. The story of this psychiatric revolution has focused largely on the years of resistance during the Occupation and on male, anti-fascist doctors. But if Saint-Alban’s legacy still appears to us as political, it is because it carries another transmission: that of the practices of women, psychiatrists and nurses, who have mostly disappeared from this history of the politics of care. This article proposes an alternative, collective narrative that politicizes the long-invisibilized roles and tasks of the women who cared for the unwell psychiatric institutions inherited from the nineteenth century.
“In this mythical story of the transformation of asylums, the presence of these big names has often overshadowed both the hospital as a place of collective life and care as well as the work of the women who shaped its new contours.”
The memory that needs to be recalled today is not only that of another form of collective life, one including the women who were clearly present. What is truly at stake is a different kind of memory of politics at the heart of institutional psychotherapy. At Saint-Alban, neither the socialist and feminist commitment of psychiatrist Agnès Masson, nor psychiatrist Germaine Balvet’s struggle to survive under the Occupation, nor the nuns’ resistance to occupation were experiences comparable to those of the male doctors. These women found another way of overturning old institutions. The practices of Agnès Masson, Germaine Balvet and the nuns of the Order of Saint-Régis resonate more with the indissociably therapeutic and political experiments that François Tosquelles had taken part in before his arrival in France: during the Spanish Civil War and in the context of the anarcho-communism of the 1930s, when sex workers and women from religious communities left their assigned roles to join what would eventually be called therapeutic communities.
While the storied men of institutional psychotherapy have been remembered for the way they transformed relations of care, it is perhaps the critical role played by women, having long remained illegible, that today allows us to rethink the historical links between care and politics. To do this, we will examine unpublished interviews and essays, nearly inaccessible papers and historical documents, as well as films made by François and Elena Tosquelles, which bear witness to this other transmission, as we develop a way of thinking about the psychiatric institution along the lines of revolutionary political processes. It is largely through the testimony of François Tosquelles that traces of the thoughts and practices of Saint-Alban’s women have been preserved, along with the therapeutic experiences of Republican Catalonia and Spain in the midst of the Civil War. We have explored a range of Tosquelles’s writings, interviews, and recordings in order to discover an alternative form of the collective and a different body of the psychiatric institution among the founding narratives of institutional psychotherapy. It is above all archival work that has made this research possible, for the archives are what reveal the silences of this fabled history.
AGNÈS MASSON’S GEO-PSYCHIATRY: A REPRESSED GENEALOGY, A RADICAL CONTEMPORARY
On his arrival at Saint-Alban in 1940, after the experience of the Spanish Civil War and internment in the Septfonds camp for Spanish refugees, Catalan psychiatrist François Tosquelles inherited the hospital’s reorganization from Agnès Masson, the doctor appointed to head the establishment from 1933 to 1936. Born in Sesto Fiorentino, Italy, in 1900, Agnès Julie Chiarli fled her country because she was “opposed to fascism.” While already in France, she wrote, in her 1927 naturalization application, that “the current political regime did not allow her to live in Italy.”[2]
Agnès Masson would arrive in Lozère as the first woman director of a French psychiatric hospital, after having obtained a bachelor’s degree in literature from Besançon College then defending her medical thesis in 1929 at the University of Lyon (Nadaud 2012). At Saint-Alban, Masson focused on “modernization,” bringing running water, electric power, and central heating, ending cabanon [solitary confinement] and the use of straightjackets, and building a library and movie theater with the patients. Her “Rapport médical et administratif de 1935” [Medical and Administrative Report of 1935], one of the few remaining records from this period, includes photographs documenting the progress of her plan to expand the hospital, still only partially submitted to the Ministry for approval, which included new pavilions, a sewage system, a laundry room still under construction, and plans to build a laboratory (Masó 2021, pp. 174–187).
In March of 1947, some ten years after her departure from Lozère, a local newspaper article remains one of the few written records of Agnès Masson and includes the only known photo of this enigmatic figure. In it, she is presented as “France’s youngest alienist in charge of running an asylum,” leading therapeutic initiatives of an experimental nature at the hospital in Châlons-sur-Marne, where she was appointed in 1944. Through dance, film, theater, and set design, she is “revolutionizing methods of treating the insane,” “a little surrealistic,” with “mixed troupes” made up of hospital staff and residents: “on stage, it becomes impossible to distinguish between them.” Shortly after her appointment, “the administration was astonished to learn that Agnès Masson was having the lunatics dance.” Unsurprisingly, they considered dismissing her, but “Chérie” had already been adopted by her patients. She kept her job. If the patients nicknamed the director so familiarly, it was because she was upsetting the hierarchies between caregivers and the cared-for. She even went a step further by opening the hospital to the community, such that “dances at the Châlons asylum are very popular with prefecture officials who go there with their families” (unknown author 1947). But the publication of this article, which celebrated her project to humanize the hospital and win over public opinion was not met with the approval of her superiors: she was suspended from her post in July 1947.[3]
“It is perhaps the critical role played by women, having long remained illegible, that today allows us to rethink the historical links between care and politics.”
Indeed, the interrelationship between the psychiatric institution and its outside is at the heart of Masson’s work in Châlons. In the context of postwar France, which saw the development of outpatient psychiatric supports (Bueltzingsloewen 2018), Agnès Masson set up a “regime of semi-liberty.” To begin with, “dialogues like this were not uncommon at the bedside of my new patients: ‘would you like to go to the cinema tomorrow? If you’re interested, we’re going dancing Sunday, would you like to come?’” Then, “as soon as Masson arrived, she relaxed the rules around entering and leaving the hospital” and “the length of stay [was] often reduced to 15 or 20 days” (Masson 1948a, p. 9). She went so far as to involve patients in deciding the length of their hospital stays: “even giving the patient the impression that she was partly the arbiter of the length of her stay: ‘when do you want to get out?—I’ve just arrived ... I’d like to get out of here, get better ...—In a fortnight?—Not possible!—but it is, try!’” (Masson 1948a, p. 13–14). Patients were also invited to get involved in the “working committee” coordinating various services at the hospital (Masson 1948b, p. 28). Masson even went so far as to make use of the occasional escape in order to establish continuity between admissions and discharges.
In Châlons, there was a great esca pe artist, delirious, remarkably intelligent, who couldn’t even be made to attend parties, as she had tried to escape several times on these occasions by taking advantage of the comings and goings. One day, she asked to come to my house to see my children, and I hesitated: “are you afraid I’ll take advantage of your trust?” the patient asked. “That would be wrong.” Two days later, she came to work for me in my home, and soon gained the complete trust of my family. She ran errands in town with money I gave her for important purchases, took walks in the countryside and drove the car with me to nearby towns practically unsupervised, all without the slightest attempt at escape. She did eventually escape on the eve of the transfer that was to repatriate her and her fellow evacuees to a facility where she knew she was doomed to lose this freedom (Masson, 1948a, p. 12).
This description by Masson herself, presented as part of a paper given to the Société médico- psychologique de Paris at its February 23, 1948 meeting, is a major document shedding light on the “geo-psychiatric” practices she had already explored in the 1930s at Saint-Alban. During these years, she traveled around Lozère in her car to pick up patients who had fled to their homes or families. It was this experiment in geo-psychiatry, understood as “migrant labor in the region,” that would be taken up and deepened by the psychiatrists of institutional psychotherapy from the 1940s onwards. According to Lucien Bonnafé, “this astonishing character who preceded [Paul] Balvet, named Agnès Masson, had bought one of Citroën’s auto-chenilles [half tracks] from la croisière jaune ou noire[4] to pick up the patients! It was part of Saint-Alban’s fleet.” These were the beginnings of “geo-psychiatry,” which was not yet so named, and which would be continued by the work of the Society of Gévaudan: “The Society of Gévaudan at the time called geo-psychiatry a psychiatry that existed only in terms of its integration with human geography ... This tradition was put to use in the sense of an entirely new conception of public service outside the hospital, and we continued to seek out the mad in their homes. We would go in groups, as a team, and take advantage of the opportunity to stop and do outpatient treatment” (Bonnafé, Tosquelles and Daumézon 1975, p. 89).
The psychiatrists of institutional psychotherapy such as Bonnafé and Tosquelles correctly recognized geo-psychiatry as the beginning of French sector psychiatry, officially starting in the 1960s, with its critique of hospital-centrism in favor of providing care outside its walls: “we called it geo-psychiatry: it was, if you like, the first name, the first verbal identification of what was, let’s say, a sector-type practice” (Bonnafé, Tosquelles, Daumézon and Tosquelles 1975, p. 89). Yet neither in the history of institutional psychotherapy nor in the history of French sectorization were Agnès Masson’s geo-psychiatric practices subsequently recognized as part of the genealogy of the asylum’s transformation: even in Lucien Bonnafé’s benevolent and grateful testimony, Dr. Masson’s work was part of a “mountain tradition” that institutional psychotherapy would “put to use in the sense of an entirely new conception of public service.”
François Tosquelles was an exception: it was he who best transmitted and solidified the permanent legacy of Agnès Masson’s psychiatric work at Saint-Alban, and who, a few years after her direction, invented institutional psychotherapy. Among the many measures she introduced to humanize life at the hospital, it was the abolition of the straitjacket that caught Tosquelles’ attention. From previously unreleased recordings from 1986 with Jean-Claude Polack, Danielle Sivadon, and François Pain:
Madame Masson tried to loosen the hospital’s attachment to straitjackets. She called an important nun into her office along with other nurses, and put the straitjacket on the nun. “I’ll come and get you tomorrow or the day after. You let me know.” And this “to make the caregiver a caregiver and not a captive of coercion.”
Here, Tosquelles exaggerates and modifies an account given by Agnès Masson in 1948 after she had left the Châlons asylum. In this seminal scene, a woman psychiatrist and those who, a few years later, would become the nuns of institutional psychotherapy, together renounce the use of straitjackets:
In one of my previous departments, a very kindly nun expressed the idea that you didn’t have to be miserable in a straitjacket: she spontaneously agreed to try one on during the half-hour that remained before the end of the nursing class she was taking. The experience convinced her, and the whole community, and in a remarkable gesture, she proposed that I do away with straitjackets altogether (Masson 1948a, p. 11).
The end of the use of straitjackets thus preceded Tosquelles’s arrival at Saint-Alban, just as geo-psychiatry preceded the birth of the Society of Gévaudan and institutional psychotherapy. But Agnès Masson was not just a precursor of the latter. She was indeed its contemporary,[5] as we saw with the newspaper article published in 1947 during the golden decade of institutional psychotherapy. While she does not appear to have collaborated with the team at Saint-Alban after her departure in 1936, she was simultaneously developing projects to transform the institution: at Châlons between 1944 and 1947; at Saint-Venant in Pas-de-Calais between 1948 and 1951; at Sotteville and Alençon until 1952; and finally, at the Cadillac psychiatric hospital (Gironde) between 1953 and 1955, where she appears to have ended her career (Nadaud 2012). She was suspended from her duties on several occasions because of her experimental methods: despite her status as head physician, the fragility of her position lay in her isolation. Although she overturned the assignments and positions at the heart of the socializing therapeutic treatments of the time, she did not benefit from the framework or nascent networks of institutional psychotherapy that could have given her a contemporary readability. She had been deeply engaged in approaches similar to institutional psychotherapy without ever being part of it.
For Masson, the revolution of positions, in which patients and caregivers were invited to leave their familiar roles to become mutually implicated in the treatment, promised to undo the division between medical and non-medical care. In her project “to abolish everything reminiscent of the barracks” (Masson 1948a, p. 9), medical care was resignified and broadened in the practice of this psychiatrist, a woman who, already at Saint-Alban, had taken care to install an “atmosphere” and a “climate”: incorporating “small modern restaurant tables for two, comfortable seats, individual or semi-individual washbasins (for two or more patients), with towel racks, mirrors ...” and allowing patients to keep personal items such as “wedding rings and even everyday jewelry, watches, etc.” (Masson 1948a, p. 10). She also required “no embarrassing undressing in front of other patients” (Masson 1948b, p. 23). It was an approach that interweaved medical care and care,[6] care and attention (Garrau 2014). Above all, her practice questioned the nature of the links between the politics of care and politics in the more traditional sense, for the years of Agnès Masson’s great therapeutic experimentation coincided with the deepening of her dual commitment: socialism and feminism.
The relationship between psychiatry and politics for Agnès Masson remains to be examined. On the one hand, her psychiatric practice needs to be reread in light of her indissociably socialist and feminist commitment. After serving in the Resistance during the Occupation, she was elected as a socialist and served on the municipal council of Châlons from 1945 to 1947. She was a member of the Commission nationale féminine du Parti socialiste [National Women’s Commission of the Socialist Party] as well as secretary of the Groupe des Femmes Socialistes élues municipales et cantonales [Group of Socialist Women Elected at the Municipal and Cantonal level] (Nadaud 2012). In 1947, when she was appointed president of the Union des femmes élues de la Marne [Union of Elected Women of Marne], she published three books: Femmes, voici pourquoi je suis socialiste [Women, This is Why I am a Socialist] with a preface by Léon Blum, Les municipalités et la protection de la mère et de l’enfant[7] [Municipalities and the Protection of Mothers and Children] and Les problèmes de la reconstruction. Le permis de construire[8] [The Problems of Reconstruction. Permission to Build]. On the other hand, her intertwining of feminism, socialism, and scientific production has recently been criticized through the lens of gender.[9]
THE SEX WORKERS AND THE NUNS: TAKING ADVANTAGE OF THEIR ASSIGNMENTS
Agnès Masson was not the only woman psychiatrist from whom Tosquelles inherited the transformation of psychiatric practice through unsettling roles and boundaries of medical care. Yet few traces remain of these other women who lived or spent time in the hospital. Tosquelles acquired the knowledge of local medicinal plants from psychiatrist Germaine Balvet, the wife of the director, who arrived in 1935 after Agnès Masson’s directorship, but who did not have a position in the hospital. Germaine Balvet had circulated this knowledge of medicinal plants to the nuns (Masó 2021, p. 189–190), as well as her 1941 thesis, De l’organisation d’un service d’insulinothérapie (par la méthode de Sakel) et de narcothérapie dans un hôpital rural [On the organization of an insulin therapy service (using the Sakel method) and narcotherapy in a rural hospital]. For Germaine, as for her husband Paul Balvet, it was a matter of intervening in the relationships between the patients and the collective of caregivers, which was indifferent to psychological suffering, in order to hold the nurses and religious community of the order of Saint-Régis responsible for the process of administering insulin injections. At Saint-Alban, Madame Balvet was not only a wife and mother; this psychiatrist without official position published a thesis, under the Occupation, focusing on working with a collective of caregivers. She developed her psychiatric work herself, which was not recognized as such in the hospital, pay- ing close attention to the materiality of insulin therapy treatments and the awakening of the patients: this is evidenced by the few photographs and drawings of the organization of the hospital she chose to reproduce in her thesis (Guerra et Masó 2021, p. 32–34).[10]
This struggle against the indifference of the collective of caregivers, but also against the fear of the doctors themselves in face of illness, is at the heart of Tosquelles’s institutional transformation of psychiatric establishments since the Spanish Civil War (1936–1939) and well before, under the Catalan Republic, in Barcelona and Reus as early as 1931. Around 1938, Tosquelles sets up two collectives of women, the nuns of a convent in Fuente Obejuna (Andalusia) and the prostitutes of a brothel in the village of Almodóvar del Campo (Castilla-La Mancha), to provide services annexed to the psychiatric hospital in the midst of civil war.
He also worked to involve the patients themselves in the treatment process during group meetings with those rendered mute by the war. Years later, he would relate this experience to Gérard de Nerval’s L’Aurélia, which Tosquelles took as a clinical object in his French doctoral thesis in 1948: this writing declares that “it was another patient who cured him, not the psychiatrist” (Guerra et Masó 2021, p. 117). In this non-professionalizing approach, Tosquelles goes as far as to propose that prostitutes write reports on the sexual- ity of the asylum patients: they could welcome them through words, without necessarily having sexual relations with them. The condition for integrating them into care was the absence of sexuality. This also necessitated working on themselves: “by talking about the sick, [they] were able to talk about themselves” by “modify[ing] their own psychosexual structures” (Tosquelles, quoted in Masó 2021, p. 114).
These collective experiences with prostitutes are inscribed within a political history marked by avant-garde projects. During the war, in Barcelona, the Catalan Generalitat Government created the “Syndicat de l’Amour” (Union of Love) (Barriobero and Herrán 1986, p. 116), at the request of sex workers. The union legally protected sex work which enabled those in the profession to requisition a certain number of brothels in order to set their own rates. This initiative took place within the context of the collectivization of property initiated after General Franco’s coup d’état in July 1936, and which ended with the fascist victory in 1939.[11] The anarchist psychiatrist Félix Martí Ibáñez was then Director General of Public Health, who took union demands into consideration. Ibáñez was also behind the first abortion law in 1936, which was passed in Spain by the first woman minister in a European country, Frederica Montseny.
“They established a critique and an opening of psychi- atric knowledge, contemporaneous with the introduction of permanent training for care teams that would overturn the hierarchies and historical divisions that assigned them to a place and role.”
Tosquelles described this political and sexual freedom of women within the Bloc Ouvrier Paysan [Workers and Peasants’ Bloc] (BOC), the anarchocommunist anti-Stalin party founded in 1930 where he was a militant; he recalls “a group of women who talked about sex, about the freedom to get laid. It was a kind of women’s liberation front, made up of anarchist women or anarchists from the Bloc.” In 1935, he notes that within the Parti Ouvrier d’Unification Marxiste [Workers’ Party of Marxist Unification] (POUM), which came about the merger of BOC with the Spanish Communist Left, this freedom was developed within a movement marked by psychoanalysis: “Another one, a woman from POUM, she was in her last year at high school and she was pregnant. She used her stomach as a flag ... And in the middle of all this, there were analysts, allies of the women’s group” (Favre and Tosquelles 1983–1985).
Amid the Spanish Civil War, where the debate on prostitution was also prompted by the anarchosyndicalist organization Mujeres Libres [Free Women], Tosquelles set up what would eventually be called a therapeutic community on the front in Almodóvar del Campo. Psychiatrist Thomas Main did not coin the term “therapeutic community” until 1946, before Maxwell Jones created the first therapeutic communities in 1952. At the end of the 1930s, Almodóvar was a place of collective experimentation where the women were fully part of the local therapeutic context and civilian population, alongside people who, having no psychiatric training, took part in this amateur community as a team of non-professional caregivers. Alongside the women, the lawyers, musicians, men of letters and painters worked with the war-traumatized as well as working with what Tosquelles called the illnesses of “the normal man” among the medical community.
This experimental psychiatry, where the historically invisible presence of women is resignified, implements forms of amateurism that in no way contradict professional training. They established a critique and an opening of psychiatric knowledge, contemporaneous with the introduction of permanent training for care teams that would overturn the hierarchies and historical divisions that assigned them to a place and role. This was the case for the caregiver-nuns of institutional psychotherapy as well.
AUTHORIZING THE INVISIBLE: THE CAREGIVER-NUNS
During the final years of his time at Saint-Alban, Tosquelles was invited to speak at the Yerres Conference in 1960; he discussed the historical yet invisible presence of the religious communities working in the psychiatric milieu. His lecture did not specify the particular forms of their exclusion and invisibility. However, Tosquelles had begun to analyze them in other writings where he compared the nuns to the prostitutes in their shared lack of social recognition, particularly the fact that they worked for free or were underpaid. He also linked them due to their comparable break with norms of kinship with the family and, therefore, the social bond.
Subsequently, it is a question of the cared-for-caregivers relation. Understanding the specificity of the relationship between the caregiver-nuns and the residents in the hospital is crucial for Tosquelles. Having worked for two decades with the sisters of the Saint-Régis congregation, who arrived at the Saint-Alban asylum in the second half of the nineteenth century (Le Coguic 2011, p. 14), Tosquelles maintained long standing relationships with them, which upended the hierarchy of their own community. They were part of a training project for caregiver staff that was set up in 1940 by doctors Paul Balvet and Lucien Bonnafé. After his visit to the hospital in 1959, Hervé Bazin mentions in France-Soir the psychoanalytic training of the sisters following Tosquelles’s arrival:
Taking advantage of mediocre buildings, as they were, he opened them up, transformed their atmosphere, filled it with collective activities, brought forth an interior democracy, established workshops, a club, a theater, a bar-canteen, a newspaper, all under the responsibility of the patients; he instituted delegates’ meetings, encouraged parties, balls, excursions, sports; he required beauty treatments and hairdressing for the women patients, for the men, decent clothing; he shook up the administration and undertook medical training for its caretakers and even for the sisters of the community.
This did not go without incident. From his very first course on psychoanalysis, he was accused of teaching “smut” to the nurses.
The Mother Superior—who has since then become his best ally—complained. He had to go on, Bible in hand, to sanctify the seemingly complicated analyses of Mr. Freud with examples from the Old Testament (Bazin 1959).
Alongside Balvet, Bonnafé, and Chaurand, who undertook a program of professional training for staff, Tosquelles taught courses on psychoanalysis and general psychology at the hospital from the very beginning of the Occupation, “Bible in hand with the help of Saint Thomas and Saint Caesarius of Arles whose birthday we had just celebrated.” It was then that, for the first time, “the Mother superior of the community paid a visit to Bonnafé to express her indignation, and Chaurand was denounced to the Vichy ministry for teaching ‘dirty things about love’ to the nurses and children of our school of re-education” (Tosquelles 1952, p. 539–540).
At the same time, in a moment of severe food shortage, director Paul Balvet presented techniques to improve food consumption to an assembly of caretakers. The training of former guards and sis- ters as nurses was at the heart of institutional trans formation at Saint-Alban, which was a reality by the end of 1940,[12] as evidenced by the nurses’ writings and, notably, that of general supervisor Mr. Metge, published in Le Chemin, an internal publica- tion that was not meant to circulate outside of the hospital:
If there is one name that is particularly disagreeable for us to hear, as asylum nurses, it is the term “guard” assigned to us by ill-informed public opinion on the methods of modern psychiatric assistance applied to patients.
A guard suggests, in my opinion, an individual in uniform, often armed, with an athletic build, a hostile appearance, endowed with strict and precise instructions, any breach of which is punishable by appropriate legislation. You will find similar employees in carceral establishments of all kinds: county jails, prisons, penal colonies, etc., where common law offenders are held.... Our nurses are not equipped with these older means of constraint: straitjackets, vests, handcuffs, and restraints of all kinds.... All of our patients are given every hope of recovery. The statistics can prove this. We are not guards, we consider this name an insult to our profession (Metge 1948).
Following his interest in permanent training and Daumézon’s idea that “a certain therapeutic action develops when community life is offered to the patients,” Tosquelles would regret years later, at the Yerres Conference, that studies dedicated to the dynamic encounter between the nurse and patient were still nonexistent. While “numerous studies have been devoted to the doctor-patient relationship” (Tosquelles 1960, p. 31), at the time, the singularity of religious communities in the process of cure had yet to be considered: indeed, their work was inseparable from the birth of the asylum.
In his lecture, Tosquelles deploys a diacritical approach between the caregiver-nuns and the lay nurses. Through the lay staff the patients are able to glimpse, if not directly touch, a social fabric—the family and the children of the nurses, their relationship to sport and leisure, politics, reading, or money:
Here we have a veritable tree trunk, divided into father, mother, children, etc.... and each branch subdivided: father-in-law, mother-in-law, etc.... This nurse will also be connected to the local bistro, the football team, a particular political party, attached to the Administration, to the doctor. Each of these links will be dichotomized infinitely. [Alongside each lay caregiver] there will be other lay nurses, each with their own tree on their head ... a real palisade of different trees (Tosquelles 1960, p. 34–35).
On the other hand, as far as the hospital religious community is concerned, “the patient experiences frustration”: with the religious men and sisters, the knot of social and familial relations disappear. Their world is one of transcendence. “I am not tempted to ask him [while Father Plé is present in the room] of news about his grandmother,” and he appears, writes Tosquelles, “without the inexhaustible branches of earlier” (p. 34–35). Their call to religion desingularizes them in the eyes of the residents: the “hospital nuns” appear to them as “indistinguishable copies,” “replaceable” because they are “anonymous”—and this is despite the patients fully knowing their first names.
If, for Tosquelles, the lay nurses form a tree-like structure which opens onto infinity, as in social and genealogical relationships, the community of nuns resembles a type of a wheel turning in on itself: each figure marks a form of opacity and uniformity, as well as a problem of identity and substitution. They are in fact represented in the form of repetition: N1, N2, N3 ... (Nun 1, Nun 2, Nun 3 ...) and the patient “can only mark himself tangentially to the wheel”; “he can only follow the rounded curve from the outside” (Tosquelles 1960, p. 37). However, “it would be a mistake to think too quickly that this constitutional frustration with the form of the community is a fact without therapeutic significance, a simple negative.” He identifies a dynamic of frustration and lack which is not unrelated to psychoanalytic treatment, but without confusing the two: at stake is “the resemblance of this situation with the refusal of dialogue and the mobilization of fantasies that this refusal provokes throughout the course of analysis” (ibid.). However, the major difference between psychoanalysis and the relational frustration with the caregiver-nuns remains at the scene of speech. While the analytic scene allows for speech, the patients experience “a verbal restraint” with the hospital nuns, where “contacts are often silent” mobilizing dynamisms of the “pre-verbal” order (ibid., p. 41).
Beyond the discussion dealing with these “analytic effects,” Tosquelles’s communication is so historically singular, first of all, because the collective of caregiver-nuns is not only an object of study. From the very first lines, it takes the form of a prospective discussion and work in progress: “I am asking you to reflect with me ... For this I am going to ask you a few questions from a perspective you are not accustomed to. I hope I am not throwing you off too much. Above all, I want to listen to you.” (Tosquelles 1960). In this way, Tosquelles expresses the desire to authorize a view that has long remained illegitimate in psychiatric knowledge: “if we must learn something about the nature of contacts between the patients and the caregiving clergymen and nuns, it is the clergymen and the nuns who will enlighten us ... the patients as well” (ibid., p. 29). Given this, what is gleaned from reading Tosquelles’s conclusions is, in many ways, the historical novelty of this approach because “it is without doubt the first time that, before the caregiver-nuns, such problems have been addressed ... your reactions and your opinions in face of these problems are of the utmost importance for the ability to pursue our studies’’ (ibid., p. 41–42).
Strangely, none of the interventions by the women, though present in the room, were published: the interventions by the nuns of institutional psychotherapy appear neither in the first publication of the text in 1960 nor in its reprint in 1978. And this despite the desire expressed by the editors of the journal to reproduce “in near entirety” the complete discussion:
Doctor Tosquelles’s lecture at the Yerres Conference was intended to situate itself in the field of research; it aimed at provoking a discussion on an important and difficult subject, approached from a rather novel perspective. Wouldn’t it be better to involve our readers in this research by transcribing here, in near entirety, the lecture and discussion, as we were able to reconstruct them thanks to the tape recorder? (Tosquelles 1960, p. 27).
Only the clergymen speak after Tosquelles. Father Plé, Abbot Bissonnier, Abbot Roge, Father Gérasime, Father Robert, as well as the only woman psychiatrist to intervene at the end, “Ms. Doctor Rousset,” discuss at length questions of time and psychic suffering, the phenomenological approach to the psychoanalytic encounter, and the relationship between the medical and religious hierarchy. But we will not hear the voice of the caregiver–nuns: either they did not speak, or their remarks were not deemed worthy of transcription. Or perhaps their voices were genuinely not audible in the recording? The historical invisibility of their work in the psychiatric milieu was redoubled here by their silence at the very moment when their presence in this discussion was attempting to publicly name them into existence. At this very moment, when their words could have contributed to the production of a therapeutic knowledge concerning them, they were erased.
Over time, however, Tosquelles was one of the few psychiatrists concerned with transmitting the knowledge of the nuns at the hospital. Moreover, in his writings, he never ceased to record the practice of the nuns as a rethinking of medical knowledge as such. It is precisely the fear of madness and real patients that Tosquelles denounces in the historical figure of the psychiatrist; yet, this fear does not characterize the illegitimate caregiving communities: their amateurism goes hand in hand with a form of therapeutic proximity. For Tosquelles, in particular, there seems to be a radical disagreement between the authority of the psychiatrist and the practice of the caregiver-nuns. He illustrates this with one of the most remarkable recollections of Frantz Fanon’s internship at Saint-Alban, during a period between April 1952 and August 1953 when they worked together in the training courses for the nurses.[13]
One day . . . someone telephoned us, asking for the intern Fanon for an emergency at the “Terrace.” When he returned, he was angry and disappointed, because the patient, in a manner very surprising for all, had broken nearly all the windows in the ward. This was, in itself, very serious ... however, what Fanon also complained about was that one of the caregivers of the ward—a nun, Sister Carmen—did not want to transfer the patient to her original ward, against Fanon’s opinion. I had to urgently arbitrate [a] conflict between Fanon’s knowledge and the nurse’s knowledge. I attributed to this nurse a certain confidence. I thought she could try to unpack the motivation for this relapse.
In fact, what followed was forty-eight hours of effort between the patient and the nurse, without interruption, day and night. From the practice of drawings and comments, which always had a distinct sexual connotation—notably auto-erotic—the patient regained a firm footing in the most appropriate social life (Tosquelles 2001 [1991], p. 172).
CONCLUSION: AN ALTERNATIVE TRANSMISSION OF A POLITICS OF CARE
The writings of François Tosquelles, together with the films shot in Super 8 throughout the 1950s at the hospital in collaboration with his wife, Elena Álvarez (Hélène Tosquelles), are the site of an alternative transmission of a politics of care. The frames on the following spread are perhaps the only ones in which Frantz Fanon can be identified at Saint-Alban, shortly before his departure for the Algerian hospital of Blida-Joinville in 1953, where he would further develop the teachings of institutional psychotherapy. These frames are also perhaps the only ones to have preserved the memory of the collective of caregivers and the women, during treatments and injections, but also during the evenings and celebrations bringing together the residents and the villagers.
This living memory of bodies and voices, at once present and passed over in silence at the hospital, contradicts the circulated narrative of Saint-Alban, which remains a story of great men. This restored past also transforms the figure of the subject who cures institutions. If the women psychiatrists such as Agnès Masson and Germaine Balvet have offered new spatial anchors, through the means of geo-psychiatry or the medicinal resources of the surrounding landscape, which deconstruct the centrality of the hospital in the apparatus of care, the collective of nurse-nuns is the site of a historical transformation which opens up political questions concerning the forms of visibility, recognition, and formation of historically delegitimized care teams. In both cases, the women’s significant presence in the collectives is often confused with the form of the collective itself which, in the case of the religious communities, can take on the form of anonymity. Both are committed to the political task of transforming bureaucratic establishments with their inertias of reification and confinement into genuine institutions. If institutional psychotherapy calls into question the relations and the places between caregivers and the cared-for, the women generalize this questioning of roles by reorganizing the relationships between the amateurs and professionals through training. Unearthing this past buried under legend thus enables the articulation of the history of psychiatry with other analyses of care while accounting for gender as a central dimension, which is currently being developed in the field of care studies.[14]
AcknowledgmentsI would like to thank my anonymous colleagues at the Cahiers du Genre for their suggestions that allowed me to improve an earlier version of this text, as well as Éric Fassin and Caroline Ibos for their critical rereading. This article began to take form while working to prepare for the film that I wrote in 2021 with artist Mireia Sallarès, Histoire potentielle de François Tosquelles, where we gave voice to the sex workers and anticapitalist activists Verónica Arauzo and Paula Ezquerra, as well as sister Àngels Dresair and nun, theologian, and doctor Teresa Forcades, alongside psychiatrists, psychoanalysts, sociologists and students, in a project to make women’s voices heard in the legacy of Saint-Alban.
Notes[1] For a presentation and problematization of the relations between work, ergotherapy, occupational therapy, and social therapy, see my book Tosquelles. Soigner les institutions [Curing the Institutions] (Masó 2021, p. 59–63). François Tosquelles brought Hermann Simon’s 1929 essay Aktivere Krankenbehandlung in der Irrenanstalt [More Active Therapy in the Psychiatric Hospital] with him to France, and encouraged its translation, realized by Eugénie Balvet, as well as its production in the print shop run by patients at Saint-Alban. This points to the importance of the concept of activity for “institutional therapeutics.” If all work must be considered in its medical dimension, ergotherapy must not be confused with “production” for Tosquelles. It is rather an “activity,” one implying “movement” (Tosquelles et al. 1961; 2009 [1967]). As for the cooperative organization of the patients’ work, which Tosquelles apparently conceived of before arriving at Saint-Alban while working in Catalonia in the 1930s, see also Institutions et coopératives [Institutions and Cooperatives] (Guerra et Masó 2022, p. 101–102); as well as Clot (2009 and 2020), Gaignard et Molinier (2008), and Molinier (dir. 2018).
[2] I would like to thank the Archives départementales du Jura, which helped me research Agnès Masson’s work at Saint-Ylie.
[3] “The hospital’s administration remained on the offense and, perhaps further alarmed by these unwanted innovations, accused the director of being a dangerous agitator and launched an investigation (carried out by the same inspector general who would later lead the investigation of 1947), against which staff fiercely rebelled. Protests from staff at the Ministry, repeated interventions by the CGT ...” (Masson 1948a, p. 4).
[4] Translator’s note: a vehicle with two wheels in the front and tank treads in the back, used in the racist la croisières jaune and noire [the Yellow and Black Cruises], early motorcar expeditions funded by Citroën that crossed Asia and Africa, respectively.
[5] For François Tosquelles and Claude Poncin, institutional psychotherapy only became a true movement with the Liberation: “It wasn’t until the Liberation that this movement, timidly and painstakingly embodied in the practice of Fleury-les-Aubrais and Saint-Alban, was translated into a certain general effervescence. The revamped governing bodies; the Union des Médecins Français, which at the time was rallying the hopes of the resistance around the Debré Plan; the traditional learned societies—i.e. the Société Médico-Psychologique and Évolution Psychiatrique—and, the Syndicat des Médecins du Cadre, converged around the National Psychiatry Days from 1945 to 1946” (Tosquelles and Poncin 1961, p. 12).
[6] English in original.
[7] As part of the Fédération nationale des Élus socialistes municipaux et cantonaux.
[8] Published by Fédération nationale des Élus socialistes municipaux et cantonaux, Groupe des Femmes élues, Union républicaine de Châlons-sur-Marne.
[9] I invited Paul Preciado to write on Agnès Masson’s book, Le Travestissement. Essai de psycho-pathologie sexuelle [Transvestism: An essay on sexual psychopathology], which was published in 1935 when she was working in Saint-Alban. Preciado questions Masson’s leftist feminism as the very thing that, through the prejudices of the time, enabled her to conceive of cross-dressing “as a pathology warranting psychiatric institutionalization”: “Feminism and transphobia could then (and still can) go hand in hand. The understanding of sexuality to which Masson’s thinking and some of her successors, such as Frantz Fanon, refer is as conservative as that of the classical alienists’” (Preciado 2021, p. 160). However, it is worth asking: was such pathologization not the rule at the time? Perhaps what marks Masson and Tosquelles distinct is their bracketing of sexuality, which was nevertheless an object of discussion in their political circles when imagining a politics of care and which may be due to confrontation with a psychoanalysis that was conservative on this point. In any case, Masson’s theoretical work makes no connection with her practice, unlike her work in the 1940s. What remains to be rigorously researched are the medical (and sexological) sources as well as the photographic archives Masson drew from during the years of writing her book. Beginning with Doctor Desruelles at the Saint-Ylie psychiatric hospital in Jura before her arrival in Lozère, Le Travestissement must have been informed by Masson’s case notes, which would now provide a better understanding of her internment policy preceding the Saint-Alban and Châlons experiments.
[10] Nusch, the wife of Éluard, and Cécile Éluard, the daughter who he had with Gala, were also involved, according to Tosquelles, in the psychotherapeutic treatments during their stays at the hospital. Neither of them had any psychiatric training. Having worked as an artist at the Grand Guignol Theatre in Paris in the early 1930s, Nusch Éluard (Maria Benz) collaborated in the psychotherapeutic treatment of schizophrenic children through theater workshops when she accompanied her husband to Saint-Alban between November 1943 and February 1944. Cécile Éluard, who worked as a schoolteacher during the war, stayed at Saint-Alban after the liberation during the summer of 1945. She resided at the home of Lucien Bonnafé where Tristan Tzara and his son Christophe also stayed. A couple of months later, under the pseudonym Cécile Agay, she published an account of the women who were patients at the hospital in the Communist journal Les Étoiles: “Not all patients stay locked up. Some of the women (and for the men, it is the same) can leave to go to the village, to the countryside, in complete freedom. Others work outside of the hospital, at the homes of the doctors or on the farms. They are given children to look after. They love them very much” (October 9, 1945).
[11] See Decret collectivització de les empreses industrials i comercials [Decree on the collectivization of industrial and commercial enterprises], July 1936.
[12] Regarding the formation of the nuns, see the account of psychiatrist Roger Gentis, who arrived at Saint-Alban in 1956: “I think that Tosquelles’s great concern was that I should not be against the nuns. He had a certain regard for the work they were doing, they were already well trained and he was afraid that a fundamental anticlericalism would emerge, which would have been serious, because among the sisters, there were two or three who were quite remarkable” (Rousseau 2013, p. 28).
[13] See the filmed interview with Juliette Pradine in Martine Deyres (2019), Les heures heureuses [Our Lucky Hours]: “We began courses in 1951-52-53. And we took them [the exams] here. I think there were 16 or 17 of us who passed them. They were the first courses we took.... I passed it here in 1953, with Fanon, with Tosquelles. The first part was on general care treatment. And the second part was really psychiatry.
[14] Translator’s note: English in the original.
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