How to Live in Prickly Conditions
Notes on group life, psychosis, and politics in psychoanalysis
*What follows is a paper I read for the Minnesota Psychoanalytic Society’s Fall Conference: “Integrating Community and Psychoanalytic Approaches to Psychosis” on November 23rd. I present it here with a few edits for easier reading and with a handful of ad-libs added into the text. At root, it’s a summary of what I’ve learned about the approaches taken in 1) group life, 2) psychosis, and 3) politics in psychoanalysis and, very briefly, how they come together in Institutional Psychotherapy. This is certainly more “drafty” than I prefer to publish normally, even on my blog, but, though it was illuminating and interesting for me to revisit Institutional Psychotherapy through the history of group work in analysis, I can’t see myself returning to this specific text in the near future, so I’m publishing as-is. As I state in the text, I’ve read analysis on-and-off for a long time, but always have the inkling that I’m missing something essential or drawing non-analytic conclusions from analytic texts. I’ll let the readers judge. I’d be very interested to hear your feedback. Also yes, it’s a porcupine in Schopenhauer’s parable, but Canguilhem and Giraudoux wrote about hedgehogs so I had to pick one.
I speak to you today as someone deeply invested in the future of mental health care, as someone who’s been on the receiving end of psychiatric treatment and currently works at a social space for individuals diagnosed seriously mentally ill in the city, and as someone who spends most of his free time reading and writing about psychiatric history and theory. Nevertheless, I come to you as something of an outsider. While I’ve read and admired the giants of psychoanalysis for many years, and believe at the very least that its theoretical contributions ought to be taken seriously by any mental health care program, I’ve never undergone analysis nor studied it in any official capacity with the help of a guide. And so, perhaps foolishly but hopefully not impetuously, I’m going to play the part of the barbarian at the edge of the city running roughshod over elegant Roman concepts with my chariot and hazard a few propositions about what I consider three vital though minor and seemingly neglected traditions in analysis generally, but especially in American psychoanalysis. I believe my comments hold true for psychotherapy more broadly as well, perhaps with some modifications. These three approaches or practices are 1) group work, 2) work with psychosis, and 3) an explicit, openly political orientation to the organization of therapy.
I’ve structured this talk around a parable I’ve reinvented by combining fragments and ideas from Schopenhauer, Freud, Canguilhem, and Jean Giraudoux, the keys to which I’ll reveal over the course of this talk: two hedgehogs sit on the side of the road in winter. It’s cold and they huddle up closer to one-another, but, as they do, their spines press into one-another and they are forced to retreat. Spotting better nesting grounds across the street, they decide to cross, but are hit by a car. The many drivers who pass their corpses ask themselves: what drove these creatures to cross a dangerous highway? As I’ll argue throughout this talk, this is the wrong question, but it’s the one we usually ask.
1) Groups
To begin with my three traditions, the importance of the group ought to be clearest, since, as Freud reminds us in his Group Psychology and the Analysis of the Ego, “The contrast between Individual Psychology and Social or Group Psychology, which at a first glance may seem to be full of significance, loses a great deal of its sharpness when it is examined more closely.” “It is true” he continues,
that Individual Psychology [is] with the individual man and explores the paths by which he seeks to find satisfaction for his instincts; but only rarely and under certain exceptional conditions is Individual Psychology in a position to disregard the relations of this individual to others. In the individual’s mental life someone else is invariably involved, as a model, as an object, as a helper, as an opponent, and so from the very first Individual Psychology is at the same time Social Psychology as well —in this extended but entirely justifiable sense of the words.
Even so, there is a tendency in analytic literature not only to center the individual as the true object of treatment, but also as the core object of study, and to denigrate the experience of living in groups, or view it as secondary. In the same text, though he later complicates his theory, Freud liberally and approvingly quotes from Le Bon’s description of groups as “impulsive, changeable and irritable [...] led almost exclusively by the unconscious.” Summing up his thoughts on Le Bon’s work, Freud says that the group is “entirely conservative, and it has a deep aversion from all innovations and advances and an unbounded respect for tradition.” Although he admits that the group is “capable of genius” due to the fact that it is groups and not individuals who develop “language, folk-song, and lore,” he nevertheless holds it to be a fact that “great decisions in the realm of thought...are only possible to in individual, working in solitude.” Freud’s original thesis around the inevitability of doing social psychology aside, orthodox analysis proved itself to be primarily oriented toward the individual. An analyst may go far in treating such an individual as one embedded in a social context that deserves attention and thought, but rarely do they venture to think of the group itself as the constitutive form of subjectivity.
The individual is by and large taken as the de facto subject of analysis until wartime experiences provided opportunities for—or in some cases forced—psychiatrists and analysts to work with a great number of people at once. I have in mind here the social psychiatric experiments undertaken by Maxwell Jones with the “Therapeutic Community” model and the analytic groups overseen by Wilfred Bion. Since this is an analytic event, I will only discuss the latter. Bion’s experience working with groups in the military in the 1940s and therapeutic groups with the Tavistock Clinic led him to revise and build on Freud’s brief study, primarily in Experiences in Groups. Bion makes clear quite early on that he doesn’t believe any sort of “cure” can take place in group work. “Indeed,’ he wrote “the only cure of which I could speak with certainty was related to a com- paratively minor symptom of my own—a belief that groups might take kindly to my efforts.” Most of his other observations hardly inspire confidence.
In his account, groups have a stated purpose, an official reason for convening (say, to do group treatment or to organize food distribution), which he calls the “work group,” but are always motivated and driven by what he calls a “basic assumption,” through which groups strive to preserve and reproduce themselves regardless of or even despite the work group purpose. He outlines three basic assumptions: dependency, fight/flight, and pairing. The dependent group seeks to preserve itself by looking to a leader who is treated as though they can supply for the needs of the group. The fight/flight group will hoist whoever is thought to afford opportunities for flight or aggression into a position of leadership. This group gives its members an outlet to funnel their frustrations of dealing with complex and difficult matters through some manner of venting or violence or else an escape route away from them. Pairing groups treat the group as a means of finding mates and partners, not always explicitly sexually, but is colored by the possibility. Such a group eschews concrete leaders because it is sustained by an extant messianic hope in the possibility of communion, and hope is consummated and destroyed by actually existing unities.
It would be easy to simply stop here with the pessimistic conclusion that groups have little to offer in the way of therapy, that we are destined to be unhappy in groups since we are fated to unconsciously undermine our own ends, and that the best course of action would be to funnel neurotic and psychotic individuals out of the group and into individual therapy for proper treatment. But this takeaway only works if you believe that it’s actually possible to not live and think in groups. Bion develops Freud’s intuitions about the hazy lines between individual and group psychology to say that group life is not only “essential to the full life of the individual, quite apart from any temporary or specific need, and that satisfaction of this need has to be sought through membership of a group” but, much more radically, that it is impossible to not be in groups. As he put it: “I do not consider it necessary for a number of people to be brought together—the individual cannot help being a member of a group even if his membership of it consists in behaving in such a way as to give reality to the idea that he does not belong to a group at all. In this respect the psycho-analytical situation is not ‘individual psychology’ but ‘pair’. The individual is a group animal at war, not simply with the group, but with himself for being a group animal and with those aspects of his personality that constitute his ‘groupishness’.” Humans are a group animal such that even solitariness, being alone, acquires its meaning only in the matrix of our groupishness. In Bion’s words, “You cannot understand a recluse living in isolation unless you inform yourself about the group of which he is a member.”
This is an important point for atomized Americans especially, who, through our myriad devices that mediate social encounters, our privatization of common living spaces and public goods, and our architectural predilection for privacy, can delude ourselves into thinking that each person lives on an island and only ventures out when its time to make mutually satisfactory business deals. But in reality, this situation is collectively produced and maintained. One could similarly look to the “hikokomori” phenomenon in Japan. On the surface, this looks like a possible exception to the necessity of group life, being the most extreme contemporary form of social isolation, but this too is a group phenomenon in at least two ways: 1) it’s only sustainable in collective social and technical conditions where the hermit can eke out an existance inside an apartment without leaving for extended periods of time, which requires (highly mediated) form of social interaction to procure food, keep the lights on, etc; 2) insofar as it has become a subculture, being a hikokomori is itself an expression of group belonging. Bion is thus clearheaded when he reformulates Freud’s opening salvo on the ambiguous borderland between group and individual psychology with his more emphatic notion that “the apparent difference between group psychology and individual psychology is an illusion.” Just as the hedgehog would freeze were it to completely retreat from its companion, we simply cannot exist except as a collective, but just like the hedgehog’s spines pushing the other away, our proximity to each other is painful, forces retreats, and leaves us licking our wounds.
2) Psychosis
Keep in mind that Bion is only challenging the division existing within rubrics of psychological understanding, not psychological treatments, which he, like Freud, sees little reason to believe are possible in a group setting. My intention with this paper is to complicate this notion and to argue that groups have a special status for psychosis specifically. We can approach this through the question of “reality,” that which psychosis is supposed to have a troubled relationship with.
It shouldn’t be especially controversial to state that psychoanalysis has had an uneasy relationship with psychosis since the beginning. Freud’s primary engagement with a case of psychosis, the Schreber case, is, already in its formal structure, a testament to a professional failure. Unlike most readers, I happened to read Schreber’s text long before I read Freud’s. When I finally read the latter’s I was unnerved by the fact that Schreber was alive and well and perfectly capable of engaging in dialogue with those around him when Freud wrote his study, but, instead of attempting to at least establish a distanced line of communication, he chose to use Schreber’s Memoirs as the sole document of study. Even at the level of the text, however, Freud’s reading is selective and anxious to provide quick solutions. I believe reading Schreber’s Memoirs side-by-side with Freud’s case study proves the following: in Schreber’s account, one follows a mind in an active life-or-death struggle with reality, pain, incredible transformations, a lucid analysis of Prussian forensic psychiatry and law, and institutional barriers; Freud’s analysis of the facts looks more like a static case-picture too quickly analogized to neurotic cases of his past or familiar myths from the cultural ether.
For example, Freud claims that Schreber’s accusations against Dr. Emil Flechsig are “characteristically vague and elusive,” but there is little mention of the physical torture and abuse Schreber faced at his hands or at the hands of the attendants of the institution Flechsig sent Schreber to. The accusations are actually quite clear: Flechsig committed “soul murder” and was likened to a persecutory God who “only dealt with corpses.” Freud claims that soul murder is insufficiently defined. I disagree. It was and is still not uncommon for people to refer to their self, or their “true inner self,” as a soul. Schreber says to murder a soul is “to take possession of another person’s soul in order to prolong one’s life at another souls expense, or to secure some other advantages which outlast death.” It’s hardly a stretch to connect this to the accusation that Flechsig was cruel and concerned only with professional success at the expense of his patients. Flechsig himself admitted on many occasions that he was more interested in his patients’ anatomy than their well-being.
As Henri Zvi Lothane has uncovered, “soul murder” also had a life in the German courts prior to the Schreber case. Seelenmord was used by the jurist Anselm von Feuerbach (1775-1833) in a famous book on Kasper Hauser, which Schreber was very likely to have read, as a legal term, even making reference to it in the title: Kaspar Hauser, Beispiel eines Verbrechens am Seelenleben des Menschens [Kasper Hauser, An Example of a Crime Against the Life of the Soul of Man]. Feuerbach tells the story of Hauser, a boy who was believed to have been raised in a dungeon, deprived of conversation or education. He first mentions the concept of “soul murder” when drawing up a list of crimes committed against Hauser (if, in fact, the information of the case was correct) where he uses it to describe the crime of sensory and experiential deprivation. Schreber’s indictment against Flechsig was that he committed an act of medical malpractice consisting of depriving Schreber of liberty and choice. The second accusation, that he “only dealt with corpses” is not obscure in the slightest. Flechsig was in the avant-garde of university-based psychiatrists convinced that pathological anatomy would reveal the secrets of madness and instituted what he called his “Leichenpolitik,” the “corpse policy” to procure as many corpses to study as possible from local sources like unclaimed pauper bodies. Schreber was being literal and descriptive in this passage.
It might be protested that there are many other elements I am excluding here that are far more difficult to explain like the upper and lower gods, the nerve-language, or the “fleetingly-improvised people”. It is true that psychosis concerns a relationship with reality and meaning, and that the Schreber case contains elements that are obscure and elusive, but one’s interpretation is surely weakened by not doing the detective work to discover correspondences that are not actually very obscure. Freud’s real stroke of genius comes later in the text when he says that “what we take to be the production of the illness, the formation of the delusion, is in reality the attempt at a cure, the reconstruction.” In this case, the “soul murder” and “corpse god” seem to belong more to the first than the latter, since they constitute elements of the trauma Schreber experienced and don’t seem to me to be delusional constructions. These two examples are fairly superficial, but the more time one spends doing detective work with the text, the more Freud’s study comes out at least as bizarre and strange as Schreber’s book. But in order to distinguish the primary wound from the secondary compensatory constructions, one must live among and with psychosis, be comfortable with it, be willing to have dialogue with it, something which, it seems to me, Freud was unable or unwilling to do, as evinced by his well-recorded aversion to working with psychotic patients.
To return to Bion and group life, it’s of interest to note that, in his assessment, the primary conflict that arises in group life is between the reality of the work group, which meets with the intent to complete a concrete goal, and the projections and fantasies that find expression in the basic assumptions. Reality is not equivalent to “truth.” Analysts are among the few psy-professionals to recognize this: that psychotics don’t struggle with truth and reason per-se, but with their relationship to it. In some cases, psychosis appears to be super-rational, finding causes for all sorts of things that normally go unexamined. For many analysts, what differentiates a crisis of madness from everyday madness is an inability to cope with the incongruity between fantasy and desire on the one hand, and disappointing reality on the other. In this light, group life, in its striving to defer its explicit goal through defensive maneuvers and projection are closer to the experience of psychosis than neurosis. Here I want to problematize Bion’s near certainty that treatment cannot happen in a group by questioning what exactly he meant by “treatment” and “cure.” If one of the purposes of analysis is to help one get along in the world, to accept the unacceptable, to live with one’s own madness, and, if group life is an unavoidable necessity in such a life, then I do not see how such an acceptance could come about except by embracing the frustrations and complications of group life. By successfully participating in a work group and confronting the basic assumptions, psychotic patterns are rendered more bearable, less inhibiting, less fearful. This, I think, could be said to be a form of treatment.
I have to venture into the anecdotal here and say that I that I’ve oficially worked in groups, in work or otherwise, with members deemed psychotic for about 6 years and unofficially for much longer than that. I have repeatedly observed that my experience working in these groups could not possibly differ more from the images that circulate about psychotic individuals, namely, that they are as a rule introverted into a private world, that they lack sufficient means for effective communication, and that they could not possible co-operate in a shared venture on account of this. I’ve yet to encounter this hopeless scenario. In fact, there are some clear communicational advantages to organizing activities and actualizing plans in these groups over groups comprised of so-called “normal” individuals. My initial hypothesis as to why is that, when psychosis is present, nothing is off the table and the group unconscious is closer to the surface. You can’t pass over the “simple stuff” or the “obvious questions,” which are in reality never simple and obvious, because they are now an issue. Fantasies and conflicts that usually boil under the surface are tangible and open for discussion. Myriad unsettling, confusing, or cruel things we do to one-another that normally must remain unspoken are impossible to avoid. In the “normal” group, fantasies, projections, anxieties, and assumptions run rampant but are kept close to the chest, such that openly discussing them is tantamount to violating a sacred oath. To name an obvious and general example, we as a society are by now aware that current rates of CO output spells the certain death of humanity and yet we collectively sustain fantasies about what’s necessary to get by in day-to-day life ensuring mutual inaction. This everyday form of collective suicide in the name of pleasantness and cohesiveness is perfectly acceptable despite how dire our sitution is. One could say the same thing about the genocide we are witnessing in Gaza or about the global turn to ultra-right politics. I find myself wishing we all had the clarity of mind that the maddest of madmen, Antonin Artaud, had when he said that “contemporary life preserves itself in its old atmosphere of lechery, anarchy, disorder, delirium, dissoluteness, chronic madness, bourgeois inertia, psychic anomaly..., deliberate dishonesty, flagrant hypocrisy, sordid contempt of everything which shows distinction, laying claim to a whole order founded on the fulfillment of primitive injustice—an order of organized crime, in fact.” For Lacan, the psychotic is someone who takes things seriously.
One could accuse me of overgeneralizing. Indeed, there is no sharp, ready-made distinction between “psychosis” and “non-psychosis” in group life, nor is there a single “psychotic” or “neurotic” type or relationship to truth. What I mean is to say that we all struggle with the truth we confront in reality: right now, most people deny too much truth and fail to act with the gravity demanded by our times; while many in psychosis fail to act because they take in too much truth all at once and are paralyzed by the enormous consequences of every decision, every look, every casual remark. The psychotic crisis, like any crisis, can invoke panic and despair, but it can also be a time to reassess and confront that which we overlook and ignore. Those who isolate and exile psychosis from their midst abdicate this sort of truth. If we are stabbed by the spines of the other, this can either be a time for panic or retreat or it can be taken up as an opportunity to take a step back and discover new ways to nestle up without prodding one-another.
3) Partisanship
I will return to these points at the end, but suffice it say here that expanding group opportunities for people experiencing psychosis is not presently likely given the general social fear of psychosis, the lack of interest and initiative to palliate the condition of those experiencing it, not to mention the paltry state of social cohabitation more generally in our atomized world. The most common group scenario designed specifically for psychosis in the past was a congregate prison-like hospital; it’s hard to imagine any grand unifying project would be substantially different in our current horizon. Here we can see, following Canguilhem’s observation, that the drivers’ question about why hedgehogs cross highways is wrong: hedgehogs don’t cross roads by any design of their own; it’s the roads that cross the paths of hedgehogs. People in psychosis are not simply withdrawn, antisocial, and fail to get along in the world because of their “natural” constitution; social conditions and the built world put innumerable obstacles in their way, forcing them into forms of group life that are dangerous, infantilizing, and anemic in jails, hospital wards, group homes, prisons, nursing homes, under bridges, in the close quarters of the publicly subsidized apartment complexes or the hyper-surveilled shelters.
That is why, in my view, any program oriented toward psychosis will by necessity be political in character. I will go further and say that psychoanalysis and the psy-disciplines more broadly open themselves to enormous risk when they avoid organizing themselves politically because to refuse political economic questions means to accept the typical class stratification of mental therapeutics: psychoanalysis or psychodynamic therapy plus material and occupational supports for the well-off and custodial care for the poor. Insofar as analysts generally work in the private sphere with few opportunities to take advantage of state subsidy, their clients have historically tended to be in the middle class or above. Since we know that the poor have higher rates of psychosis than their better-off contemporaries, it is a statistical certainty that the average analyst will have less interface with psychosis than their peers in psychiatry.
Freud and his colleagues in Red Vienna refused to accept this as inevitable and fought to establish free clinics, made 1/5 or more of their caseload gratis, and sought to increase their interface with the poor whenever possible. It was in this spirit that the Poliklinik was opened in Berlin and the Ambulatorium in Vienna. these projects led the early political analysts down two paths of development that were lost in depoliticized circles: 1) a tendency toward “social work” or interface with the public and children represented most clearly by Wilhelm Reich’s Sex-Pol, which combined materialist analysis and psychoanalytic insights at the theoretical level with individual therapy and social work and sex education at the practical level; and 2) an awareness of the need to develop techniques for working with psychosis exemplified by the work of analysts like Heinz Hartmann, Paul Schilder, and Ruth Mack Brunswick’s work at the Department for the Treatment of Borderline and Psychoses attached to the Ambulatorium.
What happened to those clinics and analysts who attempted to remain “apolitical?” The truth is, the so-called “depoliticized” strains of therapeutics remained entirely political, they simply wear the camouflage afforded them by accommodating themselves to the ruling regime and its needs. In Europe, when the leaders of the psychoanalytic clinics accepted Aryanization and Nazification, when they accepted the exile of their Jewish peers, or when the major organizations and institutes refused to publicly support the leftist professionals who opposed the Nazis, they acted completely politically. People like Ernest Jones politically bargained that the survival of analytic institutions in occupied territories was more valuable than preserving the progressive elements of analysis. To make a point clear through a negative example, I said before that whenever mental health professionals strive to increase their interface with the poor, they see the necessity of developing techniques to work with psychosis. The opposite is also manifestly the case: wherever states strive to be done with the poor, as the Nazis did, programs are oriented towards eliminating psychosis by mass murdering asylum inmates, as in Germany, or letting them die, as in France.
This was the conclusion of the great analyst Marie, or “Mimi”, Langer, who was just finding her bearings in Vienna as a young medical student when the Nazis came to power. After she witnessed a Hitler speech in Germany in 32’, she decided to join the communist party, in her words “the only political party to comprehend the real danger of Nazism.” She turned to analysis when the new Austro-fascist policy prevented her from getting clinical training because she was Jewish. Soon after, however, she would be met with great disappointment when the Viennese Institute continued to try to maintain a neutral posture by banning members from participating in political groups. As she rightly opined, this was tantamount to accepting fascism and the exile of Jewish or other non-Aryan practitioners as the status quo. Langer spent the rest of her life practicing Kleinian analysis in impossible political situations, usually while on the run: first as a nurse in the Spanish Civil War, where she supported partisans against Franco; then in authoritarian Argentina, where she first helped found the Argentine Psychoanalytic Association, clandestinely treated political dissidents and formed political analytic organizations to combat the continued neutral posture of the World Congress of the International Psychoanalytic Association; when the authorities threatened to kill her in Argentina, she fled to Mexico where she helped to establish a Mental Health Commission to study the effects of political repression and torture; and later, she would go to Nicaragua to assist the Sandinistas in creating a rudimentary mental health system.
To make a point clear: the actual therapeutic encounter is not in-itself a political act with specific political ends, but the political analysts recognized that the conditions of treatment is a completely political question. In other words, it is not the case that the purpose of therapy is to produce progressives or revolutionaries, but rather to assert that no therapeutic technique succeeds on its own merits and no patient receives treatment simply because they need it, but that these things must be fought for in contingent political-economic conditions.
Institutional Psychotherapy
The tendency that tied these three elements together most tightly was probably Institutional Psychotherapy. To save time, I will have to skim over the exciting formation of this group, except to say that its founders like François Tosquelles were professionally forged in the fight against fascism in Europe and its techniques were worked out by necessity in concentration camps and occupied territories. Doubtless due to the tumultuous founding scenes where nothing was guaranteed, where everything conspired to drive everyone mad, where group work was foisted upon them and one worked with whoever was on hand rather than seasoned professionals, the three tendencies I’ve covered were never even a question for Institutional Psychotherapy.
After developing his practice in the Septfonds concentration camp fleeing from Franco’s terror, Tosquelles assumed directorship of the Saint Alban psychiatric hospital in France, where his team initiated widespread reforms, many of them oriented towards bolstering opportunities for group life: they started many clubs and committees for patients to take control over various aspects of daily life, they held festivals, started journals, bars, gardening programs, art groups and more. What had to be avoided was the comfort and passivity of distinct roles and positions. Everything had to be put into motion; the world had to invent itself anew everyday. For Tosquelles, “What counts is not the head, but the feet. Knowing where you put your feet. It is the feet that are the great readers of the world, of geography”. His experience of being a migrant and a refugee is doubtless tied to this attitude: he said that “The human is a creature that goes from one space to another, she cannot stay all the time in the same space [...] That’s to say that the human is always a pilgrim, a creature who goes elsewhere”. The patient club, in which political power was invested, was one of the major innovations. Patients were asked to make significant decisions for the hospital and could contest decisions made from the staff. Isolation, cliques, and “egocentrism” were to be combated with festivals, parties, and the reorganization of roles to shake things up and create new connections or associations. In this way, a principle of freedom and experimentation, the ability to remake yourself everyday, became part of the therapy.
At a later institution called La Borde, they instituted a complex grid for redistributing roles and the division of labor on a regular basis to produce new social arrangements and “frame the disruption”. This ensured that nurses would wash dishes, doctors would farm, staff members would perform routine medical tasks, and residents would lead art classes. Félix Guattari, one of the younger members of the movement, emphasized in his work that, thanks to this arrangement, the same person could be a patient one day, a nurse at another, and the analyst at another. This constant changing and shifting was meant to break people free of the seriality imposed by other institutions, so that they could, in Guattari’s words “reappropriate the meaning of their existence in an ethical and no longer technocratic way.” To understand Institutional Psychotherapy, you must think of therapeutics as a question as much of ecology and geography as psychopathology.
In fact, for the clinicians involved in IP, it seems no one had taken Freud and Bion’s insights about the blurriness of group vs individual life to its logical conclusion. In their view, processes like transference are at base social phenomena, which are at least triangular (involving patient, therapist or clinician, and outside social relations), but this is already generally acknowledged in some fashion. More radically, they saw no outer limit to group phenomenon, but only groups within groups within groups (family is contained within community collectives contained in nation states and so on). To draw this to its conclusion, a group is not a composite thing comprised of a series of individuals; rather, an individual is something abstractly cleaved from the whole, without ever being able to maintain real autonomy from that whole. So it was not a matter of “creating groups” but of fostering or reorganizing those that already exist and will form regardless of what they do. Furthermore, they did not think it justifiable to abstract these gropus from their geography and language, but viewed these as the matrix within which all thought and action occurs. Framing therapeutic encounters in this way increases both the practical opportunities for intervention and experimentation and the risk involved, insofar as they departed from typical and accepted patterns. In this light, the greatest evil attributed to the concentrationism and custodialism of institutional psychiatry was that these tend to produce a mass of rigid, unchanging, narrow subjects, in other words “career patients” where the isolation and repetitiveness of each bolsters the same in others. In a properly therapeutic group environment, the joke told by those associated with Institutional Psychotherapy that the doctors “are the chronic cases” because they stay in the institution while the patients “are the ones passing through” always holds true.
Guattari described these transformations by appealing to the difference between what he called group-subjects and subjugated groups: “The hierarchy, the vertical or pyramidal organization, which characterizes subjugated groups is meant to ward off any possible inscription of non-sense, death or dispersal, to discourage the development of creative ruptures, and to ensure the self-preservation mechanisms rooted in the exclusion of other groups. Their centralization works through structure, totalization, unification, replacing the conditions of a genuine collective ‘enunciation’ with an assemblage of stereotypical utterances cut off both from the real and from subjectivity... Group-subjects, on the other hand, are defined by coefficients of transversality that ward off totalities and hierarchies.” This may at first seem like a restatement of Bion’s distinction between work groups and basic assumptions, but Guattari offers us a new way of formulating the task of the task. Physical space, geography, architecture are like languages that groups speak by moving and associating in various ways, and their arrangement determines what can be said or done. Transversality refers to the capacity to “cross,” to move between milieus and roles in an active way in order to “maximize communication between different levels and different meanings” without succumbing to either vertical command structures where the only enunciation possible is an echo of the leader’s Word through the ranks or the rigid horizontality of a sterile hospital ward where everyone repeats the same words because all anyone has to talk about it how they too are just another sick, lost soul.
Institutional Psychotherapy stands as a testament to the possibility of experimenting with therapeutic group work in seemingly impossible conditions, and that analysts can be a key part of that work. Even when not directly engaged in group work or work with psychosis, analysts can be on the front lines pushing wherever possible for adequate social spaces or countering fearful rhetoric about the dangerous schizophrenic by reminding people of our shared psychic experiences and structures. Some may be feeling that the recent election puts the already embattled and small corps of people engaged in trying to transform the mental health care system on the defensive for the next four years. That may turn out to be the case in specific moments and situations, but a permanent defensive position is not going to bring us one step closer to the better world.
Let’s conclude with our hedgehogs crossing the street. The fact is: we cannot control the seasons—the harsh reality of winter will continue to bash us with cold winds and ice—but we can build a world where hedgehogs and mice and lions and, yes, even psychotics can move about more freely, to discover and try out new pastures and companions as befits their need, so that they may not only avoid dying needless deaths, but overcome difficulties together towards stimulating and more fulfilling lives in common.
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