On Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France

MO: As a starting point, it doesn't seem to me that institutional psychotherapy is well known or discussed in the American psychoanalytic world. Can you provide some introduction?

CR: I would say that there are two ways to answer this question. The first one is to explain how institutional psychotherapy came about and the second is to say a little bit more about the theory itself. Institutional psychotherapy was born during the Second World War, in a small village in France called Saint Alban, where a group of psychiatrists gathered for different reasons. On the one hand, they were horrified by the death toll in psychiatric hospitals during the Second World War. We've all heard about the policy of forced euthanasia of the mentally ill and cognitively disabled that the Nazi regime carried out, but we don't know as much about what is sometimes called the “soft extermination of the mentally ill” carried out by the Vichy Regime, allowing the mentally ill and disabled to die of cold, hunger, and lack of care in the hospitals themselves. In France, about 40,000 patients died during the war in psychiatric hospitals. These doctors were aware of this humanitarian crisis and wanted to do something to help their patients survive by hoarding food, with the help of the local population, and trying to continue providing care. So, this is one of the historical roots of institutional psychotherapy.