I never once encountered Frantz Fanon on the page in my nine years of Canadian medical training. He is not in the medical curriculum at all. This year, I read his available psychiatric writings in Alienation and Freedom, a collection of Fanon’s lesser-known work translated into English by Steve Corcoran and published by Bloomsbury in 2018. I learned that many of my assumptions about his work as a psychiatrist was wrong. First, I had assumed that his years in psychiatry were in his later years, and that his revolutionary activities preceded them —wrong. I had assumed that psychiatry and revolution were distinct phases of his life —wrong. I had assumed that his views were ready-made, without struggle and without fallout —again wrong.
Fanon’s first permanent posting as a psychiatrist was at St. Blida Hospital in occupied Algeria. He had just completed his psychiatry training in the French medical system and passed his qualifying exams. The year was 1953. He was 28 years old. St. Blida was a massive hospital with over a thousand patients. With his colleagues, Fanon attempted “institutional therapy” to re-socialize his patients in hospital. He took a very natural sciences approach in his paper “Social Therapy in a Ward of Muslim Men: Methodological Difficulties” to disprove his null hypothesis that the method of socialization was the same across patient demographic. In the ward of French women, activities like staging plays, basket weaving, and choral singing improved morale and shortened hospital stay. While in the ward of Arab men, staff could barely get engagement with the same activities. The treatment failed. Fanon wrote that it was easier for the doctors to converse with the French women on any number of topics of mutual interest but clinical visits with the Arab men through an interpreter were extremely brief. He likely had little in common with the native Algerian, as a Lyon University trained psychiatrist and former soldier of the Free French Forces, whose appointment to a psychiatric hospital in Algeria came from the French Minister for Public Health and Population by way of the Governor General of Algeria.
It took Fanon three years at St. Blida before he resigned. He wrote to minister Robert Lacoste in December 1956: “For long months, my conscience has been the seat of unpardonable debates. And their conclusion is the will not to lose hope in man, that is to say in myself. My decision is not to bear a responsibility, at whatever cost, on the false pretext that nothing else is to be done.” (435). The order for his expulsion from Algeria came in the new year.
Any narrative that describes Fanon as arriving in Algeria pre-primed to join the resistance is unsubstantiated. I would argue that his day-to-day front line psychiatric work was foundational to developing his politics. I would even go one step further to say that his evolving viewpoint on freedom and on society are psychiatric and political in nature – that is, one and the same.
“Out of fear of patients, or in order to punish them, the patients were left in secure units,” Fanon wrote, “sometimes shirtless, without mattresses, or without sheets… agitation, restraint, agitation — always kept a veritably concentration-camp mindset.” (361). Fanon was describing the conditions of the psych wards at St. Blida, but it remains a valid critique of psych wards today, one hundred years after Fanon’s birth. While many of the biologic treatments of Fanon’s time have become museum-grade artefacts, the milieu of the psych ward with its colonial overtones remains largely unchanged.
During my time working on psych wards, I have seen the same cycles of agitation, restraint, agitation play out. Reactive institutional policies bordering on the hysterical are commonplace: take away pant drawstrings so that everyone’s pants keep falling off and are constantly humiliated, revoke a patient’s off-ward privileges after a suicidal gesture, or worse, chemical sedation or physical isolation because staffing levels can’t keep up. This is my observation of modern psychiatry’s constant defensive hostility. Ask ourselves how a therapeutic relationship can exist when the mere possibility of patient suicide is interpreted as the ultimate attack on staff – documenting every exhaustive detail not because it’s clinically relevant but because there’s a slight chance it will be reviewed in litigation. Reacting to every patient action because then no one can say not enough was done. Fanon said it best: “Each time we disregard our profession, each time that we give up our attitude of understanding and adopt an attitude of punishment, we are mistaken.” (346).
Fanon’s approach in St. Blida had been to implement rigorous re-socialization in hospital. He sought to re-create as much of outside society in the wards. He started a journal where patients could contribute their writing, football teams and matches were had, a football stadium was set up, and a Moorish cafe was established. For all these accomplishments in “institutional therapy,” Fanon later in his career would give up this approach entirely.
In the months before and after Fanon formally resigned from St. Blida, he joined the FLN (Front de libération nationale). Then he was expelled from Algeria and relocated to Tunisia. Anyone reading his life story might assume that in these months he experienced a fallout with the profession of psychiatry after seeing the limits of psychiatric work towards collective liberation – that he would not be able to reconcile the life of a political revolutionary and activist with that of a psychiatrist. This was not the case. He practiced psychiatry in Tunisia and continued to write about his psychiatric work there until his death at age 36.
His next papers from Tunisia described the implementation of a day hospital model. Patients would arrive at the centre in the morning and leave after supper. Instead of bringing the world inside the ward, Fanon pushed for a model of minimal institutionalization. He pushed for patients to start treatment in their pre-existing environment. He argued that whatever interpersonal and worldly dynamics contributed to their illness would not be remedied by the artificial bubble of the psych ward, and that it was futile to mimic society within the institution as he had attempted at St. Blida. In fact, he believed “isolating a mentally ill person within a psychiatric hospital means carrying out a second internment. The patient has already been expelled by the social milieu, which has requested his sectioning under the 1838 law.” (440). And that second internment subjected the patient to the same reflex that resulted in his or her first ousting from society. Fanon was determined to work towards humanization and not to replicate those systems that worked against individual and therefore collective liberation. “The a minima master/slave, prisoner/gaoler dialectic created in internment, or in the threat thereof, is radically broken,” he wrote in 1959 in “Day Hospitalization in Psychiatry: Value and Limits. Part Two: Doctrinal Considerations”: “In the day hospital, the doctor-patient encounter forever remains an encounter between two freedoms. That condition is necessary for all therapy, but especially in psychiatry.” (497).
Fanon worked and struggled against the colonial structures of psychiatry his entire life. Structures that I continue to struggle with today living and working in settler-colonial Canada as a psychiatrist. Many times I would have liked to quit all together but have not yet. Anyone who has worked in psychiatry knows its limits as a radical practice, especially Fanon. Anyone who has worked in psychiatry also knows the impetus to imagine more radical systems of care and futures. For Fanon, it oriented his work unambiguously towards freedom.
Emily Lu is a poet, translator, and psychiatrist based in Toronto. Her work has been nominated for awards such as the Pushcart, Best of the Net, and Desperate Literature Prize, and was selected for Best Small Fictions. She is the author of two chapbooks: Night Leaves Nothing New (Baseline Press 2019) and There is no wifi in the afterlife (San Press 2022).
Works Cited
Fanon, F., Young, R. J., & Khalfa, J. (2018). Alienation and Freedom. Bloomsbury.