The Ethic, Phenomenology and Diagnostic of post-war French Psychiatry Thesis submitted to the University of London for the award of Doctor of Philosophy By, David Reggio Goldsmiths College, Department ofHistory, University of London November 2005 1 Abstract of Thesis The thesis seeks to examine the ethical, phenomenological and diagnostic renewal of psychiatry in post-war France. The particular focus of study will be to bring to light (1) the emergence of a psychiatric movement that was to become known as Institutional Psychotherapy in 1952, (2) the inauguration of a particular post-war clinical sentiment of sympathy, (3) and the more specific developments of the psychopathology of schizophrenia undertaken by Dr. Franyois Tosquelles and Dr. Jean Oury. The thesis is composed of three chapters: The first chapter of the thesis, presents a bi-focal analysis of a philanthropic politic characterising two significant moments of medical reform, where psychiatry finds its Hippocratic and Apostolic definition as a vocation addressing the imperial need of man. The first moment, is that of Philippe Pinel in a Post­ Revolutionary France, who urged for more specialised spaces employing the non-violent treatment of the insane. The second, is the German Occupation of France, where the psychiatrist's personage in the questionably 'free' Vichy South is one that is dramatic and resistant. This historical study is conducted in order to bring to light the methodological shift within the history of European psychiatry: what was the art of medicine and alienation for Pinel of the Paris Pitie Salpetriere, is extended and redefmed as the art ofsympathy and dis-alienation for those of the clinical fraternity of Saint-Alban. The second chapter, observes the 1948 doctoral thesis ofDr. Franyois Tosquelles and the conditions of its emergence. Addressed is the "polydimensional" approach of Institutional Psychotherapy in its marrying the psychoanalytical, the biological, the theological, the neurological and the phenomenological, and as to how such an approach reasons the negation of madness to be said of a positive, constructive, aesthetic and industrial paradigm The third chapter seeks to demonstrate the empirico-phenomenological attitude of Institutional Psychotherapy by observing the works of Dr. Jean Oury, Jacques Schotte, Viktor von Weizsacker and Henri Maldiney, and as to how they pertain to a "pathic" diagnostic of schizophrenia, a diagnostic of the felt rather than the thought, where the psychiatric symptom is at once empirical and transcendental. 2 Table of Contents Acknowledgments 4 Introduction: Institutional Psychotherapy 6 Chapter 1: Soft Extermination, Hard Times 30 Chapter 2: The end ofthe World Experience 104 Chapter 3: Psychiatry and Phenomenology: An Introduction to the empirico-phenomenological attitude 181 Postscript: Towards the Ethic ofPsychiatry 270 Appendix: An Interview with Dr. Jean Oury 285 Select Bibliography 306 3 Acknowledgements An immeasurable gratitude is extended to Professor Howard Caygill for his continual, unwavering support, indefatigable interest, and for recognising a passion; Dr. Jean Oury of La Borde clinic for the trust instilled and the many hours of invaluable conversation and hospitality; Dr. Mauricio Novello of the Osvaldo Cruz Foundation for his proven friendship and visionary clinical insight; Professor Paolo Amarante of Osvaldo Cruz, Brazil, for his honest interest in my work; Dr. Zbigniew Kotowicz for Jazz-filled conversation; Mr. Eduardo Rego and Mr. Andrew Aitken for a rare camaraderie and fraternal encouragement, and finally my wife Jung Aun and son Eugene for filling my life with that rare and very necessary transcendental majesty- "}'it. - Om Mani Padme Hum. 4 The Diagnostic is not etiquette, it is an ethical undertaking ... To perform a diagnostic is of the phenomenological - Dr. Jean Oury, La Borde Clinic, 11th September 2004. 5 Introduction: Institutional Psychotherapy We don't set out to establish a true catalogue of technical attitudes. We merely want to indicate several possible directions that have proven successful. - Franc;:ois Tosquelles, Education et Psychotherapie Institutionelle1 1: Research and methodology This present study will defme the historical and conceptual grounds upon which the psychiatric movement known as Institutional Psychotherapy stood, and still stands, as a significant therapeutic enterprise. 'Institutional Psychotherapy' is a psychiatric and anthropological project, one that is synonymous with four names: Franc;:ois Tosquelles (1912-1994); La Borde Clinic (1951-), it's founder and director Dr. Jean Oury (1924-), and his protege, the philosopher Felix Guattari (1930-1992). The term Institutional Psychotherapy was proposed in 1952 by the psychiatrist Georges Daumezon (1912-1979) in an essay entitled La psychotherapie institutionnelle fram;aise, and it appeared in the Portuguese Journal, Anais Portugueses de Psiquiatricl. This naming came one year before Dr. Oury established the clinic of La Borde within an old, noble, chateau in the picturesque region of Cour-Chevemy- the very year a young Guattari of sixteen years found himself at the clinic under Oury's guidance and philosophical orientation. A great age of renovation followed the end of the Second World War and the Liberation within which philosophical and clinical questions were re-assessed in the light of lived historical experience. Much of the theoretical activity that hallmarked La Borde clinic was in fact developed at the wartime of Saint-Alban: Institutional Psychotherapy was not only born from an age of socio-cultural renewal in the wake of Occupation, but from a great philanthropic and scientific effort during the Occupation. Both these stages mark a "psychiatric revolution" and the base to Institutional Psychotherapy. A chronological history of Institutional Psychotherapy is yet to be written. In French historiography, this history exists through the wealth of intermittent writings not only by the founders of the movement, notably, Tosquelles and Jean Oury, but also by the present day clinicians, patients, and researchers associated with La Borde clinic. Notably, the foremost narrative of Institutional Psychotherapy 6 is penned by Dr. Oury's long-term cohort Dr. Jean Ayme (1924-) entitled Essai sur l'histoire de Ia 3 psychotherapie institutionelle • Such texts have been widely published and disseminated, and particularly during the 1980's and 1990's Jean Oury's publications attracted a global allure. Oury's acclaimed Creation et Schizophrenie of 1989 and L 'Alienation of 1992, remain the most widely circulated collection of published 4 seminars • Other texts and correspondences by Oury, Tosquelles, Guattari and Jacques Lacan remain unpublished and the very great number of essays, interventions and jointly held seminars are archived in the library of La Borde. Our study, in turn, will draw upon a selection of published and unpublished generational material that is pertinent to seizing the fundamental aspects to Oury's and Tosquelles' Thought, and concomitantly, to understanding the sense, intention and value oflnstitutional Psychotherapy, its wartime seeding at the clinic of Saint-Alban, its post-war formation in the wake of Occupation, and the philosophical and psycho-pathological questions working the machinery of Institutional Psychotherapy. Yet it is important to remember, that a concise history of Institutional Psychotherapy is impossible, simply because it is always being redefined, with each and every clinician-patient encounter- with each and every concrete metapsychological encounter. Institutional Psychotherapy, as with psychiatry and psychoanalysis (the difference of which merely exists within the mind's of the practitioner), is always in the making, is never concluded and never firmly delimited. Like the phenomenon of humankind itself, it is far from being a conclusive monograph, but merely attempts to tum within a good direction. The thesis will explore the Thought of Oury and Tosquelles by also drawing upon the writing of Lucien Boannfe (1912-2003), Jacques Schotte (1928-), Henri Maldiney (1917-) and Horace Torrubia (1917-1999). Rather than providing a chronological exegesis of these writings, we seek to harness their phenomenological and anthropological essence with the minimum of intellectualisation. These authors each equally necessitate a historico-conceptual examination beyond the limits and demands of our present study, and the thesis does not provide a hermeneutic reading of their work. Rather, we aim to show the fraternal sentiment for a medical philanthropy and anthropological medicine shared by a post-war group of clinicians, and thereby seek to understand how this informs the enterprise of Institutional Psychotherapy. To further support the guiding idea of a medical philanthropy to the post-war ethic, phenomenology and diagnostic of French psychiatry (Institutional Psychotherapy), we will also draw upon the phenomenological philosophy of Kimura Bin (1931-), Eugene Minkowski (1885-1972), Erwin Straus (1891-1975), Hubertus Tellenbach (1914-1994), and Viktor Von Weizsacker (1886-1957). In doing so, we provide an unwritten history, or even a secret history, of phenomenology and psychiatry on the Continent 7 and move towards a deeper understanding of the psycho-pathology of schizophrenia and the historical conditions and philosophical questions pertinent to its advance. In English medical historiography and practice, there is yet to be an attempt to engage with the question of Institutional