Unbehagen Psychoanalytic Salon

Scheiderman:

For the record, schizoanalysis was concocted by Pierre-Felix Guattari (and Deleuze) at the Clinique de la Borde in the Loire Valley in France. As it happens I was working at a sister clinic in the 1970s so I was quite familiar with what was going on at La Borde. It’s worth noting that the most important treatments at La Borde and the other sister clinics involved institutional psychotherapy– which created a social organization for the patients, and medication. They believed the insulin shock treatment was the best way to treat schizophrenia and even made a film about it. They liked electroshock treatment and prescribed every psychiatric medication that available– from neuroleptics to antidepressants to anti-anxiety and tranquilizers. The director of La Borde– Jean Oury– was shocked one day to hear a pharmaceutical representative tell him that he liked institutional psychotherapy because La Borde ordered as much psychiatric medication as anyone else.

Von:

That’s true. There were still problems with La Borde. But you have to remember that it was the first of the anti-psychiatry centers developed after the war. They were trying to move away from old practices – especially Guattari. He developed his “institutional analysis” here first including increasing critiques of these antiquated treatments. As for schizoanalysis it originated out of the intersection of the experiments at La Borde, Lacan’s school, May 68, and Deleuzes’s experiments at Vincennes and it grew into something much more. Its history and its future have hardly begun to be told. It speaks directly to “the ends of analysis,” “the last psychoanalyst,” and “the future analyst.”

Schneiderman:

FYI– the institutional psychotherapy (it wasn’t called institutional analysis) movement came out of the Spanish Civil War through the efforts of a man named Rene Tosquelles. It was not part of the anti-psychiatry movement. In fact, Jean Oury, who ran La Borde, hated anti-psychiatry. This despite the fact that David Cooper was working there. The clinics were very pro-psychiatry and, as I will re-emphasize, used every form of psychiatric medication available. Since they had opened in a time before the new medications were available, they understood well what happened when you did not give out the medications. I have no idea what experiments they were talking about at La Borde, but beyond the medical treatments–even outmoded treatments like insulin shock therapy–they emphasized organized group activities. In my view it was better than warehousing patients because it obliged them to participate in a social organization. The Parisian Lacanians at the time had nothing against the psychiatric clinics, per se, because they offered good psychiatric treatment, but they did not want to have anything to do with the ramblings of Guattari and Deleuze, which they considered to be irresponsible and quasi-delusional. Given their love for radical leftist politics, the people running the Loire valley clinics also sought inspiration from the Cultural Revolution in china. Some of them even traveled to China in order to see the wonderful things that the Red Guards were inflicting on psychiatric patients. Most of these people were crackpot radical leftists. They were less interested in curing mental illness than in using mentally ill patients to overthrow the capitalist order.

Von:

I think we are stressing slightly different things. Institutional Psychotherapy as a general movement was similar to what you describe but La Borde tried to move further away from that model with its own methodological innovations. It was different than Laing’s work and they were critical of each other, but La Borde is still usually considered part of anti-psychiatry in general. Guattari remained part of Lacan’s school throughout and applied analytic ideas not present in the other institutional psychotherapy centers. Institutional Analysis became Schizoanalysis, a movement developed by Deleuze and Guattari moving away from La Borde and trying to extend Lacan’s ideas in new directions. What they developed is traced in Anti-Oedipus, A Thousand Plateau’s, Schizoanalytic Cartographies, and Chaosmosis.

Benvenuto:

Stuart says some truthful things about La Borde. (I have not seen Stuart for more than 20 years, and yet I allow myself to call him by his first name, as I did in the past). But his view is only one side of the coin of the truth.

I spent a few days at La Borde in the early 70s when I was a student in Paris, but I had very close friends who had been patients or psychiatrists there. I am still in touch with some of them. My “guide” at La Borde was a dear friend, a former patient there—now a University professor—who often accompanied friends there because she was enthusiastic about the Clinique de La Cour-Cheverny. And she had undergone some electroshock there… After spending one day at La Borde, a psychologist in our group said: “This is a place where I could spend a nice summer holiday”. And not just because the clinic was in a wonderful countryside setting with woods, horses, and an old castle.

I had had experience of some psychiatric hospitals both in France and Italy at that time, and it was clear, from the first glance, that La Borde was not like the prison-asylums that these other institutions were at that time. La Borde had the air of something very different about it. Even though there were some very seriously ill patients, the atmosphere at La Borde was very “communitarian”, funny in a certain way. When the same psychologist who had wished to spend a summer there later had some personal troubles, she told me dramatically: “Please, Sergio, if I go crazy, bring me to La Borde, and nowhere elsewhere”.

When Jean Oury – a strict Lacanian, and director of La Borde – was reproached over using electroshock, he said that he found itdecisive with very depressed patients, and that the harsh attacks against electroshock were partially the result of Big Pharma’s campaign. In fact, electroshock is very cheap, while drugs are expensive. At La Borde, pharmaceuticals were of course used, as they were everywhere, but can any anti-psychiatrist today get rid of them completely?

Guattari, like Deleuze, was anti-psychoanalysis, as everyone knows. But I find it positive that a Lacanian (and Binswangerian phenomenologist) like Oury hired, for years, someone anti-psychoanalysis like Guattari. In fact, Oury invited a lot of people to collaborate who did not share his ideas, but for whom he held a personal esteem.

I can compare my experience at La Borde with another experience, less known, I guess, in the Anglo-American world, but famous in Italy and in other “Latin” countries: the anti-institutional psychiatry led by Franco Basaglia. In Italy, everybody knows him as “the modern Pinel”, because he was able to impose, in 1978, a famous law (180) that strictly forbids any kind of psychiatric hospital in Italy. If anyone is interested, I can explain how psychiatric patients are treated in Italy.

Basaglia and Oury hated each other because their aims were (or appeared) opposed: Oury promoted a cure of psychosis through a new kind of “open” institution, Basaglia promoted the complete destruction of any psychiatric institution. This is why the British anti-psychiatrists (Laing, Cooper, Esterson, etc.) sympathized rather with Basaglia.

I spent months working at the psychiatric hospital of Trieste in 1971, where Basaglia was the director just so that he could try to shut down the hospital–something he (at least formally) achieved in 1978: no more psychiatric inmates in Trieste. And of course, Trieste became a gathering place for a lot of “crackpot radical leftists”, as Stuart writes, “using mentally ill patients to overthrow the capitalist order”. But this was the Stimmung of the epoch. La Borde and Trieste – like the well-known anti-psychiatric communities in London – became magnets for artists, intellectuals, philosophers, and “crazy” reformers, etc. But at that time this mess was seen as a sign of vitality. Basaglia, who was anti-psychoanalysis like Deleuze and Guattari, felt closer to Foucault.

Basaglia’s experience inspired in Italy the movement of “therapeutic communities”, which is still widespread and alive. Their reference is Maxwell Jones’ community in Scotland, but also La Borde.

Basaglia himself told me that he recognized the efficacy of electroshock for certain patients, especially for melancholics, but in Trieste they did not practice shock therapies because of the violent and “shocking” connotation of these treatments. Yet in Trieste, his doctors made more use of psycho-medicines than La Borde did. This is why some say that “Basaglia was able to achieve his dream – destroying psychiatric hospitals – thanks to psycho-medicines”.

I think that the only two facilities in the world where psycho-pharmaceuticals were banned systematically were Soteria and Emanon by Loren Mosher.  But I wonder why Mosher’s experiments were never repeated. Were they perhaps too expensive? Actually, all Italian “Basaglians” whom I know make use of psycho-pharmaceuticals, and accept the principle of Compulsive Treatment for critical cases (although in Italy “compulsive treatment” cannot last more than two weeks). The only difference from traditional psychiatrists – but it is an important one – is that “alternative psychiatrists” (be they anti-psychiatrists, institutional or anti-institutional psychiatrists, psychoanalytically-oriented psychiatrists, etc.) use drugs because these “help”, but they think that they do not cure and they are not the only cure that psychiatry should offer. This was an assumption common to all these “shrines” of 60s-70s (anti)psychiatry.

I have recounted my experiences here only to underline the fact that issues like shock therapy, psycho-pharmaceuticals, and anti-psychiatry are very complicated, and we should avoid simplifications or any sort of black-or-white evaluations.

Beyond their contrasts, a common feature united all these 60s-70s movements: THE IMPORTANCE OF LISTENING TO PATIENTS. I don’t know about the US, but the habit of listening to patients is now rare among Italian psychiatrists. They make a DSM diagnosis about you in two minutes, and quickly write you a prescription for some drugs. It’s the triumph of short psychiatry. In our more naive times, it was longer.

Perhaps the time has come to make American analysts and psychiatrists aware of this golden age of European psychiatry in the 60s and 70s, when psychiatric issues were discussed on the front pages of newspapers, and Guattari’s and Basaglia’s public lectures attracted crowds. There was a lot of leftist crackpots, of course, but there was not just that.

Von:

Well put. These issues are so complex. Some Americans are aware of this history. I came in at the end in the 80s when I was very young. After working with Laing’s and Guattari’s circles while training in psychoanalysis I came to the conclusion that both La Borde and Kingsley Hall had problems. And most of anti-psychiatry had disappeared by then anyway. But the ISPS has kept the integrated tradition of psychoanalysis and anti-psychiatry alive internationally and in America. A new wave of anti-psychiatry arose in America from ex-patients – people abused by the system – and it is attempting to merge with this European tradition with some difficulty.

I worked with Loren Mosher (who got his original ideas from working with Laing) before he died. I have his research documents on Soteria. It was more successful AND cheaper statistically than hospitals and drugs. So why was it not continued? Not enough influence to change the prevailing model – or systematic repression of alternative medicine and psychiatry. Take your pick. Soteria used “non-therapists” chosen and trained for certain abilities to listen, not judge, and tolerate suffering of others. The houses had virtually no rules and patients could come and go as they liked. They advocated no drugs, used as few as possible and saw getting patients off them as one of the statistics of success. (Maybe that’s why the model was shut down.)

So in the end Mosher starting developing a new model of working with outreach in homes and crisis in situ. Similar ideas developed in Scandinavia with a combination of outpatient psychoanalysis and placement in homes with certain families similar to Mosher’s selection of “non-therapists.” This avoids the economically unfeasible in-patient issue but maintains the essential need for social connection and support.

I adopted and adapted many of these ideas in my clinic but added something else – “alternative psychiatry”: psychiatry developed in traditional medicine, homeopathic medicine, naturopathic medicine, orthomolecular medicine, and other methods. Even with all of this the questions and possibilities are extremely complex and difficult. As you suggest no one who has not worked on this problem should minimize or over-simplify the issues.

Having said all of this, the point remains that “schizoanalysis” was and is something very different from anti-psychiatry, institutional psychotherapy, or leftist politics. Guattari remained a psychoanalyst, and a student and analysand of Lacan. He was not anti-psychoanalysis. Schizoanalysis is a form of psychoanalysis “in extension” into questions of social, political, and economic relations by means of art, poetics, mathematics and complexity science – all things that Lacan was working on in his last years.