‘We Took Care of the Network’

Sometimes a line forms outside an old Georgian building overlooking the New River in the small town of Radford, Virginia. Tourists take turns roaming the halls, as often as three times in a day, the last round a flashlight tour. They want to see ghosts. Perhaps a young boarder, from when the building served as a Lutheran school at the end of the nineteenth century. (The ghost-hunters claim, probably apocryphally, that many bullied students committed suicide.) But more likely someone later held on the premises as a patient, who couldn’t leave in their lifetime—or in the afterlife.

In 1916 St. Albans was purchased by Dr. John C. King, who turned the school into an asylum. Under King’s watch, it offered a range of coercive “treatments”: insulin coma therapy, electroconvulsive therapy, hydroshock therapy. But King also thought that fresh air and fresh food were conducive to cure, as was work: inmates gardened and, it seems, made art.

There are few archival photos of the building when it served as an asylum, but in none of them is there a gate or fence. The surrounding lands are open. In a drawing from around 1920, currently on display in an exhibition at the American Folk Art Museum in New York, however, an unnamed patient has added a gate, adorned with stone sculptures of the heads of smiling and staring women. It is a psychic, ghostly presence only the patient could have seen.

The artist also takes a ghost’s-eye view. Rather than adopting the perspective of a patient on the inside, they look at the scene from outside and above, as if both dead and free. Inside the hinges of the gate lies its crest and the word “home.” The picture expresses a contradiction fundamental to the model of conventional psychotherapy in the asylum. The institution is cast as a space of refuge from an unwelcoming society—but it is a sanctuary you can’t leave, at least not easily.

This American St. Albans is much less famous than, and has no direct relation to, its French namesake—an old castle in the country’s south that was converted to a sanatorium in 1825. After a hundred years of ordinary—which is to say terrible—psychiatric care for the mad, in the early twentieth century the French Saint-Alban went through a period of drastic change: the health ministry appointed in quick succession a string of progressive doctors, including Agnès Masson and Paul Balvet. As Joana Masó shows in her study Tosquelles. Curar les institucions,¹ Masson and Balvet set about rehumanizing their patients: restoring the rooms, adding mirrors, dispensing with straightjackets.

During World War II, the asylum became the site of something like a miracle. Roughly 40,000 people died in France’s sanatoria during the Nazi occupation; some scholars have argued that the facilities lost so many patients not only from wartime hardship but also because the Vichy government let inmates starve or freeze to death. And yet Saint-Alban lost strikingly few patients, for a variety of reasons: its rural isolation, which insulated it from government control; its relationship to the surrounding town, which kept it stocked with food and provisions; and, not least, because it was home to a Catalan psychiatrist named Francesc Tosquelles, who was gifted with the ability to reimagine the practice for any circumstance.

Collection Family Ou-Rabah Tosquelles/Photograph reproduction: Roberto Ruiz

Francesc Tosquelles in the garden of the Saint-Alban psychiatric hospital, circa 1944–1945; photograph by Romain Vigouroux

Collection Family Ou-Rabah Tosquelles

Francesc Tosquelles (fourth from left) with Dr. Jaume Sauret and Spanish Republicans at the Septfonds concentration camp, 1939

Baldran Collection, Saint-Alban-sur-Limagnole

An aerial view of the Saint-Alban psychiatric hospital, circa 1960s

During his two decades at Saint-Alban, Tosquelles worked with other psychiatrists, a team of nuns, and his patients to pioneer a movement that would become known as “institutional psychotherapy.” Unlike the later movement for anti-psychiatry, developed in the 1960s, including by Tosquelles’s own students, institutional psychotherapy stopped short of doing away with institutionalization altogether, but it proposed undoing the hierarchal arrangements that governed the typical asylum and establishing reciprocal relations among patients, staff, and society at large. Everyone wore the same clothes. Many of the asylum’s walls—both those within buildings and those that made up the premises’ outer perimeter—were demolished. Patients still had individual psychoanalytic sessions, but the emphasis was on group activities and cooperative life. As Tosquelles put it, “We took care of the network.”²

One way to do that was to encourage patients to make art. If at the Virginian St. Albans art seems to have been a form of occupational therapy, at Saint-Alban it was a way for patients to reenter economic exchange. Their artworks were exhibited outdoors, hung up on a gate just outside the asylum, then sometimes sold or bartered to residents in the neighboring village. Soon they travelled more widely. In 1945 the painter Jean Dubuffet arrived at Saint-Alban to acquire work for his collection of what he called “art brut”—literally “raw art,” an analogue to the concept, in the US, of “outsider art.” Eventually he succeeded, setting work by institutionalized artists such as the sculptor Auguste Forestier next to those by the likes of Antonin Artaud.

It has become a familiar progression: psychiatrists offer therapies to patients, who make artworks, which collectors and institutions then acquire and exhibit before the public. In this case it culminates, for now, at the Folk Art Museum. Curated by Masó, Valérie Rousseau, Carles Guerra, and Edward Dioguardi, “François Tosquelles: Avant-Garde Psychiatry and the Birth of Art Brut” is the last stop of a four-venue touring exhibition about the encounter between psychiatry and the art world at Saint-Alban. Hovering over the show is the fact that Tosquelles himself was suspicious of this pipeline from acquisition to exhibition. After all, he resisted Dubuffet’s attempts to acquire his patients’ artworks for years.

In January 1940, the year France fell to the Nazis, Balvet went looking for new staff. Having heard about Tosquelles’s work in Barcelona, he sent for the young doctor, who was living in a nearby refugee camp the French ran for the nearly half-million Spanish refugees who had fled the civil war. Even as asylum seekers were dying from the horrific conditions, Tosquelles ran a mental health practice for them. He later claimed he did his best work there, “in the mud.”

Born in Reus in 1912 and raised in Catalonia, Tosquelles was precocious. By twenty-two, having finished university and medical school, he was a psychoanalytic patient and a psychiatrist himself at the Instituto Pere Mata; he steeped himself in the milieu of the Austrian refugees who had fled fascism and established a “Little Vienna” in Barcelona. In 1936, when the leftist Popular Front came briefly to power, he served as the head psychiatrist for the Republican Army, experimenting with group therapies for wartime trauma. Three years later, he escaped Franco’s Spain on foot.

By that time Tosquelles had come to believe that it was necessary to bring patients and staff into horizontal relations with one another. To that end he called for upending basically every precept of psychiatry. He joined Saint-Alban at the rank of nurse; in 1942 the institution took up still more of his methods after Balvet was replaced by Lucien Bonnafé, who ran with surrealists in Toulouse and during the war became a resistance fighter with a keen interest in the filiation between the mad and the avant-garde.

By 1942 Saint-Alban’s workers were protecting their own patients as well as taking in dissidents and artists from elsewhere. Resistance fighters were cached away on the upper floors, returning the building to its earlier use as a fortress. The asylum thus became a meeting place for communism, psychoanalysis, and surrealism. This was the setting in which Tosquelles hoped to put institutional psychotherapy into practice.

In her book Disalienation: Politics, Psychiatry, and Radical Philosophy in Postwar France, which includes the most substantial discussion yet in English of Tosquelles’s experiment at Saint-Alban, Camille Robcis writes that Bonnafé called institutional psychotherapy a “philosophy of the no.”³ It proclaimed, as Robcis has written elsewhere, “a ‘no’ against the ideal of scientific neutrality, detachment, and objectivism still prevalent in mainstream psychiatry, but also, relatedly, a ‘no’ against totalitarian politics and its biopolitical assault on the cognitively disabled.” Tosquelles, like the other dissident psychiatrists with whom he worked, refused to oppose madness to sanity by making the latter a norm. Instead he conceived of madness as alienation, which he used (playing off the word’s double meaning in French) to mean both one’s inner psychic state and the external predicament of estrangement under capitalism.

The aim was therefore disalienation. To “disalienate” one’s patients entailed making an asylum that could cure not just a few residents of a ward but psychiatry as a practice and eventually society as a whole. “When I think back to this period,” one doctor on staff, Marius Bonnet, later said, “I often wonder: in Saint-Alban, who cured who?”

Tosquelles knew, in other words, that for patients to be cared for, their institutions and their doctors had to exist in a better world, one that institutional psychotherapy might help bring about. This sounds lofty, but the observation that environments produce psychological illness had practical implications. Tosquelles ventured that if patients subjected to violent treatments in overcrowded, dirty asylums got worse, then they might improve if given humane treatments and civil rights, in asylums that were open to society.

The radicalism of this idea cannot be overstated. At Saint-Alban patients had the freedom to come and go—Tosquelles argued that “the first right of man is the right to wander”—and significant control over their lives, their treatments, and their labor. They went on day trips, explored the community, and worked in the fields for local farmers and peasants, who in exchange kept the asylum stocked with food. Tosquelles held group psychoanalytic sessions for psychotic patients—often rejected by more traditional practitioners of the talking cure—and encouraged everyone to participate in a patient’s organization called the Club, set up to function as a union, which also published a newspaper (patients and staff, including Frantz Fanon, both wrote for it).

He also took an expansive approach to diagnoses. The point for Tosquelles was for them to work for patients—and he was not above juking the stats to that end. He gave an example in an interview: say a patient could have tuberculosis—they looked enough like they did. Suddenly they were diagnosed with it. Why? The government offered tuberculosis patients better food rations than it did the mad. Why not diagnose someone with a physical illness and get them access to the “right” rations?

No matter how radical this perspective was, a hospital was still a hospital and a doctor still a doctor. Tosquelles remained in favor, for instance, of interventions like shock treatment (which are having a resurgence once more). But especially by comparison to the harsh conditions patients elsewhere suffered during the war, his program was effective and humane. Patients weren’t drugged into submission. Their experience was to be given credence.

The claim that psychiatric conditions were not only psychic phenomena but also socially and politically constituted had a significant influence on postwar French critical theory. It can be seen in the work of the antifascist philosopher Georges Canguilhem, who hid out (and learned a great deal) at Saint Alban and later wrote The Normal and the Pathological (1966); Michel Foucault, particularly in Madness and Civilization (1961) and The Birth of the Clinic (1963); Jean Oury, who in 1953 founded a famed clinic of institutional psychotherapy called La Borde; Félix Guattari, who took shelter at Saint-Alban to avoid serving in the French Army during the Algerian War, and later developed an even more radical critique of psychiatry than his teacher; and most famously Frantz Fanon, who, after a year and a half as a resident at Saint-Alban, brought institutional psychotherapy to the asylum at Blida-Joinville in Algeria.

Fanon’s insistence that coloniality has not just material but psychic consequences for both colonizer and colonized is a hallmark of institutional psychotherapeutic thought. But Robcis shows that he revised Tosquelles’s protocols from the ground up rather than merely adapting them for a different setting. The kinds of occupational therapies that worked in one place didn’t necessarily work in another. This was itself in keeping with Tosquelles’s insistence that the revolution in care needed to be continuous—or else it was no revolution at all.

Patients had been making art at Saint-Alban for some time before Tosquelles showed up. Auguste Forestier, perhaps the most famous artist to emerge from within the asylum, had been an inmate since 1914—confined there after sabotaging some train tracks, which resulted in a derailment. As early as the 1930s, he was already making toys out of wood for the children of the people who cared for him. Of the nearly two hundred objects in the New York exhibition, about a sixth are either by Forestier—wood-carved forks, knives, spoons, ornate toys—or are images of his work. Interspersed with them are films Tosquelles and his wife made on Super 8, mementos (including Fanon’s ID card), copies of the Club’s newspaper, and other artworks by patients that ended up in Dubuffet’s collection.

The show also reunites Forestier with some of the artists who lived and worked beside him. Benjamin Arneval was sent to Saint-Alban after he mistook his brother for a ghost on the family farm and shot him. All four of his drawings on display relate to this disaster: agricultural tools and animals feature repeatedly. Marguerite Sirvins, a seamstress who came to Saint-Alban after a diagnosis of schizophrenia in 1932, specialized in embroidered fabrics depicting familial scenes. Her most famous piece was also her last, a white wedding dress woven from the threads of unraveled bedsheets. While making it, her doctor related in a note reproduced on the wall text, she fantasized that “she was eighteen and that when she will come of age, she would be able to marry a suitor of her choosing.”

Among the dissidents and Jewish refugees who took refuge at Saint-Alban in the 1940s were the poets Tristan Tzara (a “president of Dada”) and Paul Éluard (a founder of the surrealist movement), both of whom lived with the patients, participated in the asylum’s daily life, and made art. After the war they returned to Paris, where Éluard arrived carrying artworks by Forestier and stories about the Catalan healer in a castle in the south. Suddenly patients like Forestier were in the collections of artists like Picasso.

Lille métropole musée d’art moderne, d’art contemporain et d’art brut, Villeneuve d’Ascq

Marguerite Sirvins: Landscape with Boats, Hunters, and Animals, circa 1944–1955

Collection de l’Art Brut, Lausanne

Marguerite Sirvins: Untitled (Large Blue Vase and Figures), 1944–1957

According to Masó, Dubuffet first visited Saint-Alban in 1945 to acquire works by Forestier, which he had seen in private holdings in Paris. By then a well-known artist in his own right, he criticized the art world’s tendency to view “psychopathological art” as a distinct category from proper art. For Dubuffet, the curators of the Folk Art Museum show suggest, such artworks weren’t pathological but rather pure and “uncontaminated.” Yet this was another way of relegating patients’ artworks to a separate category. They were “uncontaminated” by mainstream art precisely because their makers were physically separated from it—something that Tosquelles sought to undo.

Tosquelles, for his part, was suspicious of the art world and its market. He wasn’t against exhibition or circulation per se, encouraging his patients to show their works outside the walls of Saint-Alban and to barter them. But he had little interest in sending out artworks to collectors’ holdings to be displayed in what he called purely “exhibitionist” settings—venues which sit at a remove from the asylum and from which the patient doesn’t directly benefit. He may also have been especially suspicious of Dubuffet, who by 1950 was known to be a Nazi sympathizer. (“I am becoming more and more anti-Semitic,” he wrote an art dealer that year.) Dubuffet’s antisemitism is documented elsewhere when his works are shown, perhaps most recently at the Barbican in 2021, though it is absent from the explanatory text that accompanies the current show.

At the Folk Art Museum, Dubuffet’s own works and items in his collection from elsewhere—including drawings by Artaud, whom Tosquelles treated at the nearby hospital in Rodez—are tucked into a separate room. This is perhaps a tell: Tosquelles and Dubuffet didn’t exactly play nice. In some cases, Dubuffet acquired work by simply going around him: Masó suggests that Jean Oury, who worked as a psychiatry resident at Saint-Alban starting in 1947, sent him art by patients over Tosquelles’ protestations. Eventually Tosquelles relented. Many of the artworks now on view in New York are typically housed in the Art Brut Collection in Switzerland.

In 1962 Tosquelles left Saint-Alban. In the years that followed he consulted once more at Pere Mata in Spain, though he stayed in France; he worked as an early tele-therapist, analyzing collective treatments via taped recordings, which he called “cassette groups.” Some of Saint-Alban burned down in 1971, but it remains a working hospital. Now called the Centre Hospitalier Francois Tosquelles, many of its original buildings are under the care of the French Ministry of Culture as historical landmarks. It lives more in homage to its past than Tosquelles would have wished. Now, near Lincoln Center, the Club is reconfigured posthumously.

“François Tosquelles: Avant-Garde Psychiatry and the Birth of Art Brut” turns in its last room toward items by patients in US institutions, none as radical as Tosquelles’s. Here we find work made across the twentieth century in every conceivable medium, from embroidered outfits to line drawings like the ghostly one of the American Saint Albans to a digital film by the artist Gabriel Mitchell called “Crazy Talk: What is Mental Illness?” (Gabriel Mitchell, son of the theorist W. T. J. Mitchell, struggled with mental illness for many years and died by suicide not long after the film was made.) The wall text links Tosquelles’s legacy to nonprofits here, like the Oakland-based Creative Growth, but it acknowledges the difference between such arts organizations and institutional settings like Saint-Alban.

There is a certain logic to ending here: the Folk Art Museum has long staked its collection on the study not just of folk artists or self-taught artists but also of artist-patients. Among its best-known holdings are the drawings and watercolors of Henry Darger, who spent five years in a mental health institution until he escaped at seventeen. The museum has policies around naming artworks in keeping with medical ethics and their highly protective standards: many of the images in the final room are untitled and unidentified to protect patient confidentially.

It’s a practice of which we can guess Tosquelles would have approved. If he was in general opposed to his patients’ works being turned into collector’s items, he put up particular resistance to Dubuffet’s request for documentation not only of the artworks but of their makers’ stories. Psychiatrists elsewhere complied happily, sending over medical information for use as artist biography. Yet despite Tosquelles’s best efforts, we now know the stories of Forestier, of Arneval, of Sirvins—and we know them not only from Dubuffet but from Tosquelles’s colleagues who tried to get the works shown.

This is the paradox of Art Brut: patients get shown most frequently when they’re fetishized as pure, outside society as an effect of being kept inside closed institutions. As much as the Folk Art Museum affirms Tosquelles and criticizes Dubuffet’s notion of Art Brut, it must rely on this method of collecting artworks to offer the show at all. It is a productive friction: the works reveal and challenge the museum’s protocols even as the show makes use of them.

The icon of the show is Forestier’s massive wood sculpture of a boat with fantastical portholes and smokestacks, which greets you when you step into the darkened museum. On the wall just beyond it looms the most widely circulated photograph of Tosquelles. In it, he is barefoot, standing in a soft lunge on the roof of the asylum, braced to support the weight of the boat sculpture. He lifts it to the sky.