Following the talk I gave at the Freud Museum on October 6 to celebrate the publication of Portraits of the Insane. Théodore Géricault and the Subject of Psychotherapy, a couple of new thoughts have emerged, connections implicit in the book that I now feel I can make more explicitly. It is unsettling but satisfying too to have to acknowledge that writing and thinking are processes over which I have but limited control – like patient and therapist, who are similarly subject to larger processes.
On the Passions and their Violence
In 1805 a medical student called Jean-Étienne Dominique Esquirol submitted his doctoral thesis at the Faculty of Medicine in Paris. It is fundamentally an essay on what was known as the “moral treatment” for the insane, that is, a treatment that relied on words and the provision of new experiences rather than on medicaments. It has a highly “Romantic” title: Des Passions, Considérées comme Causes, Symptômes et Moyens curatifs de l’Aliénation mentale.
I rather overlooked the remarkable nature of this title: “On the Passions as Causes, Symptoms and Means for the Cure of Mental Alienation”. Causes, symptoms, cure: the passions, for which we might read feelings of all kinds, are everywhere and central to everything. As thorough-going creatures of feeling, we are not just defined and distinguished by our capacity to reason; feelings can lead our reason astray, indeed lead us to reason dogmatically and ruthlessly. To help some one escape this “alienation”, the physician must engage not directly with reason, in the hope of correcting faulty cognition, but with the patient’s passions. It is not a matter of just describing or anatomising them, but of enlisting and mobilising them, sometimes in dramatic ways, and this is mandatory, if any real change is to come about.
Géricault’s five portraits of hospital inmates are informed by this therapeutic insight, and more: they also actualise it. More than mere description, in their scale and impact, and in the common space they require us to share with the sitters, they invite a live and disturbing encounter. They engage our feelings, and can shake us up and out of complacency. If they depict alienation, they also challenge us not to re-enact it and turn away, but to meet and connect with the other face-to-face. It is a multi-layered encounter, and this may account for some of its disturbing power. For in the process of meeting with the portraits we are required to face the sitters’ withdrawal and to recognise and overcome this “alienating” tendency in ourselves.
A Raft of De-moralisation and Alienation
The obvious connection I want to make is that Géricault’s art, and much other Romantic art too, is itself a form of “moral treatment”. Like the therapy that Pinel, his colleagues, students and patients were developing from the 1790s, it aims to engage our feelings and sense of our own physical embodiment in order to jolt and shock us back to our senses, to “common sense”. This is precisely what the Raft of the Medusa aimed to do: it was a sort of moral treatment for what Gericault saw as a jaded public and a corrupt body politic. If it drew on the earlier model of morally fibre-strengthening Davidian neo-classicism (rather perhaps as Esquirol drew on and developed Pinel), it added to the Davidian ethic a demand for the viewer’s fuller emotional involvement, to the point of trauma and disorientation, from which we might, hopefully, emerge wiser, more perceptive and more sober. Perhaps this can be thought about as a Romantic extension of the late eighteenth-century classical revival, through the rediscovery of another ancient paradigm, catharsis.
As such the Raft is a forerunner and model for much politically engaged modern art: think of Picasso’s Guernica for example, which like the Raft offers itself not just as an illustration or commentary on a violent, widely registered event (the aerial bombardment by Nazi planes of Basque civilians during the Spanish Civil War), but as an experience. There is a story that a Gestapo officer, visiting Picasso’s studio in Nazi-occupied Paris in 1942, saw a postcard of the painting and asked “You did that, didn’t you?” “No – you did!”, Picasso is alleged to have replied (Van Hensbergen, Guernica. The Biography of a Twentieth-Century Icon). The painting, for Picasso and now for us, was the event. As spectators – unless we opt, as perhaps the German officer did, to dismiss the painting as “degenerate art”, entarte Kunst – we are involved in it.
Available for Relationship: The Therapeutic Encounter as Event
The same holds for psychoanalysis: the analyst is not just an observer or commentator (although necessarily these too), but works in the service of a shared experience with the patient. The analytic session is an event and an aesthetic object in its own right. As Gregorio Kohon writes of the work of art, it does not communicate to the subject a meaning that is already given. There is nothing intrinsic or given or natural to the aesthetic object: the aesthetic object itself generates the conditions for meaning to be created … the work itself creates … unconscious perceptions that did not exist previously (Reflections on the Aesthetic Experience: Psychoanalysis and the Uncanny).
The patient’s willingness to enter the analytic “frame” in the first place is also a tacit acceptance of the invitation to unconscious play that is inherent in the frame’s very existence – however “concrete” or resistant that patient may also be (the Gestapo officer may have been highly resistant, but he was also sniffing around, curious). Acceptance of the frame’s invitation to activate the unconscious – to become, as André Green wrote, “the cause of the movement animating [the patient’s] speech” – means the possibility of new perception (Green, Key Ideas for a Contemporary Psychoanalysis: Misrecogntion and Recognition of the Unconscious). For as Goethe declared, back in the Romantic era, each perception is the creation of a new organ of perception:
My perception is itself a thinking, and my thinking a perception. Man knows himself only to the extent that he knows the world; he becomes aware of himself only within the world, and aware of the world only through himself. Every new object, clearly seen, opens up a new organ of perception in us. (cited in McGilchrist, The Master and his Emissary: The Divided Brain and the Making of the Western World).
More than a “corrective emotional experience”, an attempt to redress past losses or hurts, the analytic session is like the work of art – any work perhaps, but Romantic art especially, in so far as it is a kind of moral treatment that specifically aims to effect a radical opening up through feeling. It is an experience in itself, with the added potential that, through its liberating address to the unconscious, it can open up and expand a capacity for new experience, for both participants.
Alienation and the Early Alienists
In the context of social critiques of psychiatry and psychoanalysis, as developed, for example, in Rod Tweedy’s forthcomimg The Political Self (2016), it might be useful to sketch out a lineage for the concept of “alienation”. Hegel developed it from his reading of Pinel, among other sources; aliénation mentale meant estrangement both from self and from the social world of citizens. But the Pinelian alienists also recognised that this social world – especially in its evolving post-Revolutionary forms – could also produce mental alienation: through the desire for profit, through new forms of competition, through the traumata of political and social conflict. There then followed, however, a divergence in ways in which the word and the idea were applied.
The “golden age” of Pinelian alienism in France certainly contained the seeds for an organicist, medical disease model of madness and the custodial asylums of the later nineteenth and the twentieth centuries. “Alienation”, in the sense in which the alienists had used it, disappeared behind “mental illness’; alienist became psychiatrist, and Esquirol’s 1805 aliénation mentale became his 1838 maladie mentale, a discreet medical and individual phenomenon, an illness, with social effects but “internal” causes. This is a view nowadays massively reinforced by the postulation of genetic and neurological causes. Meanwhile, in his development of Hegel, Marx was to appropriate “alienation” and assimilate it to the social, economic and political, to the effects on the human being of capitalist modes of production and consumption.
Critiques of psychiatry and psychotherapy in the tradition of Szasz, Laing, or Smail might be understood as attempts to re-integrate these two strands in the meaning of word, to restore “alienation” to its fullest modern sense (its first meaning, in the Latin verb alienare, from alienus, “[an]other”, was “to make another’s, to estrange”, as in a transfer of property; Entfremdung in German). One strategy for this might be to reconnect it to the world of Pinel, with the help perhaps of Géricault’s proletarian monomaniacs. In my book I argue for such a recuperation, and for Pinelian alienism as a seedbed for a sophisticated, dialectical approach to madness-in-society that might inform and invigorate psychotherapy. Such a recuperation might contribute to psychotherapy’s self-liberation from historical entrapment in an idea of itself as that which deals with the “internal”, rather than as a human activity that, as Rod Tweedy and his collaborators write, might help us come to grips with how “internal” and “external” interact and shape each other, both in the consulting room and the political world. I would argue that analytic listening for these subtle, shifting and complex interactions – and that would mean, in my understanding, all analytic listening – is a political act in itself.
Moral Therapy and the Imagination
The Pinelian hospital in which moral therapy took place was, among other things, a therapeutic community. Patients were enlisted to help each other, former patients were employed as assistants, and the frequently dramatic, cathartic nature of the moral treatment echoes across time. The watchmaker at Bicêtre who thought he had been guillotined and had his head replaced with some one else’s head was shocked out of his delusion when another inmate mocked him for believing the story that St Denis had kissed his own head after his decapitation (Pinel, 1801, Traité médico-philosophique sur l’aliénation mentale ou la manie). Put this alongside the account given by R. D. Laing, in a lecture at the Sorbonne in 1967, of the young man at Kingsley Hall who had every reason to believe that another resident had just shot him in the groin, with a realistic Luger that made a realistic sound. In the next few seconds, discovering that he was unhurt, he “lost about 50% of his castration anxiety” and was never again so frightened of something happening to his genitals. “No interpretations could be as primitive as that dramatic action, completely unpredictable and unrepeatable”, said Laing; it was, commented Laing’s biographer John Clay, like something out of Artaud’s Theatre of Cruelty (Clay, R. D. Laing. A Divided Self).
The Pinelian hospital had quite other functions too, above all to be a space for the observation, ordering and classification of the human phenomena it gathered. This function was at least as important, in the eyes of the médecin-philosophe, the doctor-philosopher, as its curative role, and it would certainly be ahistorical to see it as aiming to facilitate a personal “journey into madness” as in a Philadelphia or Arbours Association therapeutic household – although, as I also suggest in the book, the idea of recovery by way of regression may not have been so foreign to an alienist like Esquirol’s pupil Georget. As Hegel understood, submission to the authority of the all-powerful doctor was key to treatment: once the mad patient learns to respect his doctor, he becomes conscious of his own subjective state and its collision with an external reality (Hegel’s Philosophy of Mind). A century and a half later doctor-philosophers like R. D. Laing, Joseph Berke and others also deployed the authority of their sheer physical presence and charisma for therapeutic ends, although with a specific commitment to helping the patient discover her own reality, deeply sceptical as they were about psychopathological classification and diagnosis. For all the differences between them, and the respective problems inherent in both, what the Pinelian hospital and Kingsley Hall have in common is an ideal and an experience of community, as container for violence, anarchy and chaos out of which new order and sense, and an enlarged sense of commonality itself, might emerge.
Robert Snell is an analytic psychotherapist, a member of the British Psychotherapy Foundation, and an Honorary Senior Research Fellow in the Centre for Therapeutic Education at Roehampton University. He has a doctorate in the history of art from the Courtauld Institute, and is the author of Théophile Gautier: A Romantic Critic of the Visual Arts, co-author with Del Loewenthal of Postmodernism for Psychotherapists: A Critical Reader), and author of Uncertainties, Mysteries, Doubts. Romanticism and the Analytic Attitude.
His latest book, Portraits of the Insane: Theodore Gericault and the Subject of Psychotherapy, has recently been published by Karnac.
Reviews and Endorsements
‘The scope of this book is remarkable. Robert Snell’s meditation on five portraits of mad people by Géricault is the springboard for a fascinating cultural investigation. He surveys two centuries of change in the understanding of human nature, and considers how this is reflected in changing approaches to the treatment of madness. The breadth and depth of scholarship on offer here is exceptional, and this admirable book is an object lesson in the relation of psychoanalysis to the history of ideas.’
— Michael Parsons, British Psychoanalytical Society and French Psychoanalytic Association
‘This important book is for anyone interested in how history affects who we are. In a fascinating and rigorous account, Robert Snell shows us the link between emancipatory and repressive forces in ourselves, and such forces in society.’
— Professor Del Loewenthal, Director of the Research Centre for Therapeutic Education, University of Roehampton, London
‘Géricault’s depictions of the insane are among the most compelling images produced during the Romantic era in France. Robert Snell balances art-historical andpsychoanalytic readings in an interplay between biography, intellectual and cultural history, and the history of madness and post-Revolutionary painting. Insightful questions reveal the psychoanalyst’s skilful probing, deftly integrated with keen visual analyses which clarify links between the paintings and their historical matrix. This is an original analysis, in a distinctive and engaging voice.’
— Therese Dolan, Professor of Art History, Temple University, Tyler School of Art, Philadelphia, USA