Susana Caló

Can an Institution be Militant?

Institutions are environments. Institutions operate

both socially and environmentally, in regimes that are
both signifying and a-signifying. Exploring institu-
tions’ potential for emancipation and empowerment
requires understanding them within a semiotic
framework which does not reduce institutional
relations to linguistic exchanges. This understanding
is particularly important if we want to think about
how institutions participate in the production of
subjectivity, and how they can potentiate or hinder
processes of emancipation. The meaning and prac-
tice of militancy requires continuous reassessment.
Throughout my work I have focused on alterna-
tives to mental health care which promote collective
practices of care. I am referring to the post-war
European movements of institutional psychotherapy
in France, of psichiatria democratica in Italy, and

115
 of therapeutic communities in the UK in the social
psychiatry tradition developed by Maxwell Jones. All
these were at the forefront of reforms in psychiatric
care, but remain to some extent neglected today.
Why should we be concerned about this neglect?
In recent years, it has become clear that the
mental cannot just be described from a psychiatric
or psychological perspective. The mental is a
dis pu ted and financialised object, constant prey
to quantification, mapping, and measurement,
while diagnostic tools and clinical descriptions are
increasingly influenced by the pressures to medi-
calise psychiatry. They are subject to the interests
of psychopharmacological therapeutics, as well as
governmental and private insurance logics. At the
same time, what we refer to as care is also under-
going massive transformations: it is increasingly
reduced to its psychological-physical dimensions,
and abstracted from a social-environmental context
(such as the family, the community, the spaces we
inhabit, etc). With this comes a progressive deterrito-
rialisation from spaces of existence and life practices.
Not coincidentally, care is becoming, today, a rallying
cry for both environmental and social struggles.
In view of this contemporary context, trying to
learn from the approaches to the mental and to
care developed in the post-war period is particularly
important. In this essay, I will focus on what came
to be known as the institutional analysis movement,
in the 1950s in France. I will draw in particular on
the case of the Clinique La Borde and will speculate
on institutional processes and their potential for

116 Susana Caló

emancipation and empowerment in contexts that
span the hospital, the city, and the wider social field.

Institutional Psychotherapy

The institutional analysis movement, or as it was

first called, institutional psychotherapy, has been
described as a “third moment of psychiatry”: one that
moved away from the asylum, and also away from the
psychoanalytical tradition that focused heavily on a
dual relationship between patient and doctor.1 The
institutional analysis movement was an alternative to
both the regime of the law of the classic psychiatric
hospital and the “liberal contractual” regime of the
psychoanalytical approach.
Institutional analysis criticised both of these
approaches: 1) it argued that the physical conditions of
the asylum, namely its seclusion, and rigid and hierar-
chical social relations, impacted negatively on the life
of patients; and 2) it rejected the secrecy surrounding
the dual analyst–patient relation. As an alternative to
these two paradigms, institutional analysis proposed
to transform institutions of care, changing the focus
from the individual to the collective, and using and
maximising the therapeutic potential of the institu-
tion itself in all its dimensions. In what follows I will
provide a brief account of how this emerged.

1. See Deleuze’s preface to Guatarri,

Félix. Psychanalyse et Transversalité.
Essais d’analyse institutionnelle.
Paris: François Maspero, 1972.

Can an Institution be Militant? 117

 Institutional psychotherapy movement emerged
at the end of World War II.2 At the epicentre of this
development was Francesc Tosquelles. Tosquelles
was a Catalan psychiatrist, psychoanalyst, and left-
wing militant who fled Franco’s military violence
and the outbreak of the Spanish Civil War. In Lozére,
in France, he took on the direction of the Saint-
Alban hospital in 1940.3 Isolated in the mountains,
the hospital’s condition was extremely precarious,
due not only to the scarcity of resources caused
by the war, but also to its geographic and climatic
surroundings.
Led by the need to respond to the contingencies
of war, but also by his belief that mental alienation
and socio-political alienation were intrinsically
linked, Tosquelles implemented a radical transfor-
mation of the hospital. At the heart of his project
was the idea that the hospital could no longer be
dealt with as a passive instrument or as a stable
geographical site—treatment could not be dissoci-
ated from institutional and social dynamics and thus
its architecture, its management, its habitants—were
perceived as a collectif soignant, a “healing collec-
tive.” This vision led to, for instance, the elimination

2. Although referring to the practice 3. Others who trained at (or sought

developed at Saint-Alban’s by
Tosquelles, the term was only coined
a decade later, in 1952, by Georges
Daumézon and Philippe Koechlin,
“La Psychotherapie institutionnelle
francaise contemporaine,” Anais
portugueses de psichiatria, 4, no. 4,
1952, pp. 271–312, at p. 275.
refuge at) Saint-Alban included
intellectual figures such as Frantz
Fanon, Lucien Bonnafé, Georges
Canguilhem, Georges Daumézon,
Marius Bonnet, Paul Éluard, and
Jean Oury.

118 Susana Caló

of uniforms for doctors and nurses, and also the
setting up of collective activities and opportunities
for social empowerment, such as the intra-hospital
therapeutic club (Club Thérapeutique). The Club was
an associative structure composed of caregivers,
patients and personnel (or even patients alone) that
could take charge of activities in the institution. The
Club managed the result of its work, like the reve-
nue of the cafeteria, and it also took charge of the
occupational therapy registers, outings, solidarity
funds, etc. It allowed the patients to participate on
their own care and contribute to the care of others,
limiting dependence on caregivers and personnel
and providing a sense of mutual accountability.
It was not a coincidence that one of the very first
changes that Tosquelles ordered at Saint-Alban was
to tear down the walls of the asylum: “One day, we
tore down the walls of the compound. There was no
longer a border between the hospital and the village
of Saint-Alban. […] After the war, the liberation of
the territory was also the liberation of the asylum.”4
There can be few cases of the often-repeated claim
of tearing down the walls of an institution being
so literally realised. As the hospital was isolated in
the mountains with about 600 patients, opening
the walls to allow contact and trade with a nearby
village, and access to food and supplies, was of

4. Tosquelles, quoted in Robcis, Original quote from Coince, Bruno.

Camille. “François Tosquelles “Malades, médecins, infirmiers…
and the Psychiatric Revolution in ‘Qui guérissait qui?’” Midi Libre,
Postwar France.” Constellations 23, December 3, 1991. Archives Lucien
no. 2, 2016, pp. 212–22, at p. 218. Bonnafé, IMEC, LBF 70 Saint Alban 95.

Can an Institution be Militant? 119

 crucial importance in the struggle to avoid famine.5
But it was also vital in order to replace isolation and
confinement by applying a more nuanced and inte-
grated approach to mental health care: for instance,
promoting the diversification of strategies of care,
including through non-medical services and home
visits (this became a frequent occurrence, given the
deep integration of the hospital in the village’s daily
life). This broad range of activities and early spatial
understanding of care have together been given the
name of “geopsychiatry.”
La Borde clinic in Cour-Cheverny was founded in
1953 by Jean Oury, who had trained with Tosquelles
in Saint-Alban. He was joined by Félix Guattari soon
after, who took on the administrative directorship of
the clinic four years later in 1957. Oury’s understand-
ing was that institutions of care were themselves
sick and it was necessary to treat them. He coined
the term “pathoplasty” (pathoplastie), which defined
the particular illness affecting institutions and its
pathological effect on patients. He developed the
idea that, in part, patients’ symptoms were an effect
of the atmosphere in which they lived. Pathoplasty
thus referred to the way in which disorders were
constructed in correlation with the environment. Now,
this environment referred to a whole that included
social relationships, spatial, and material factors. For

5. It is estimated that 40,000 mentally extinction. There would be no

ill people died of starvation during
the war years. A form of “soft
extermination” of the mentally
ill that threatened mental health
institutions with famine and
casualties in Saint-Alban. See
Pollack, Jean-Claude. Épreuves de
la Folie: Travail psychanalytique et
processus psychotiques. Ramonville
Saint-Agne: Éditions érès, 2006.

120 Susana Caló

example, an environment in which patients were not
accountable for their actions and had no autonomy
or control over their daily lives, had the pathological
effect of producing a patient’s lack of investment in
and engagement with their own life. Power hierar-
chies, rigidity of routines, repetitive rhythms could
also aggravate pathologies. But this did not affect
patients only: it equally affected doctors, nurses
and staff in general as these co-existed in the same
institution. Thus, therapy required intervening in the
environment itself.
For Oury and Guattari, an analysis of the insti-
tution was fundamental. As Oury put it: “To treat
the ill without treating the hospital is madness!”
To this effect, Guattari developed several activities,
like patients’ clubs or an intra-hospital committee
similar to the one in Saint-Alban. He also set up a
series of organisational protocols with the primary
goal of stimulating the autonomy of the patients,
allowing them to regain a sense of responsibility
and “the meaning of their existence in an ethi-
cal and no longer technocratic perspective.” 6
Among other activities there were patients’ clubs,
the grid, a newspaper (Les Nouvelles labordiennes),
several group committees, workshops, a theatre, demo-
cratic assemblies, etc. What is key is that the fabric and
dynamics of La Borde’s daily life were thought to offer
therapeutic opportunities of diverse kinds.

6. Guattari, Félix. “La Borde: a Clinic

Unlike Any Other.” Chaosophy.
Lotringer, Sylvère (ed.). Los Angeles:
Semiotext(e), 1995 (orig. 1977),
pp. 176–94, at p. 191.

Can an Institution be Militant? 121

 The space of the analysis was central. The main
guiding principles informing the thinking about space
were the heterogeneity of spaces, and freedom of
circulation. This, of course, had to do with a certain
conception of schizosis, which argued that the
patient benefited from being able to move and exper-
iment a diversity of experiences so as to avoid rigid or
repetitive fixations, but it also arose from a conviction
that treatment should be multidimensional: that is,
should concern the social, psychological, psychoan-
alytical, biological, and environmental.7

Heterogeneity of Spaces

In a classic hospital, medication is given in specific

places. At La Borde, medication was administered in
different spaces and by different people. The reasons
for this were twofold. Firstly, this made it possible to
break the hierarchical differences between nurses and
doctors that were inscribed in the specific functions
performed by each and attached to the specific spaces
they each inhabited. Secondly, this use of different
spaces made it possible to extend the therapeutic
space to the entirety of the institution, as all its spaces
were considered to be meaningful locations for analy-
sis. Guattari, for instance, recounts the importance of
administering medication in a multiplicity of spaces

7. Oury, Jean. “Psychanalyse,

psychiatrie et psychothérapie
institutionnelles.” VST – Vie sociale
et traitements 95, no. 3, 2007,
pp. 110–25.

122 Susana Caló

rather than in the same room or with the same people,
so as to avoid a rigid association between a place
and an experience of being subject to (or subjected
to) a passive role—in this case the act of being given
medication. In this sense, the series of events and
workshops that Guattari organised were key in provid-
ing a multiplicity of practices that allowed patients
to discover new spaces and new ways to inhabit the
clinic. As Oury explains: “It is a matter of working in
a random field in which there can be unexpected,
multireferential investments, in a polyphonic dimen-
sion that cannot be programmed, but which can
indirectly manifest itself, if there are no structures that
prevent this manifestation. The equipment cannot
obtain this dialectical dimension. Our question is how
to create a collective machine, a club—which is a part
of it—that holds everyone accountable at all levels
allowing for unexpected effects.”8 Architecture was
thus a non-negligible therapeutic vector: “What does
it mean that a patient goes every day, for months, to a
dark space in an unfrequented service staircase? […]
And the window, a place of opening to the beyond, a
jump to death, a traditional phobic object!”9

8. Oury, Jean. Interview. By Almeida, 9. Oury, Jean. “Architecture et

Carvalho Mendes de, et al. “O Bom Psychiatrie.” Recherches. 06
e Mal Estar.” Pereurse 44, 2010. Programmation, architecture et
Web. 1 Nov. 2016. psychiatrie, 1967, p. 272.

Can an Institution be Militant? 123

 Freedom of Circulation

For this heterogeneity of spaces to work therapeuti-

cally, the ways in which patients and staff circulated
through hospitals had to change as well. The daily
activities of the clinic had to allow patients to meet
with caregivers, other patients, and even the outsiders
who were occasionally invited to take part in hospital
activities. This concern was central to the practice of
institutional analysis.
As Delion remarks: “The heterogeneity of spaces,
groups, therapeutic activities, and interstitial times
[…] is of great importance in the multiplication of
possibilities of the palette. But, if the patient cannot
move freely so as to be able to take part in all of
these ‘transfers’—even partial, fragile, multiple—that
heterogeneity is useless. And this is not only phys-
ical movement—rather a freedom of movement as
encompassing the ‘psychic’.”10
If for Oury and Guattari the hospital environment
should include a wide heterogeneity of spaces
(both in terms of their “atmosphere” and their
function), this was because it could act as a basis
for therapeutic opportunities. As Oury says it was
vital that there would be “a structure that makes
it worth it to go from one point to another […] a
whole tablature of differentiation, that is to say a
kind of table of distinctiveness, at that moment we

10. Delion, Pierre. “Thérapeutiques

institutionnelles.” EM-Consulte,
EMC-Psychiatrie, 37-930-G-10,
2001.

124 Susana Caló

can go from one point to another, knowing that
each point we will arrive at will not be the same as
the first. It is ultimately a table of structure: free-
dom of circulation requires that there be a table of
distinctiveness. But for this to happen, there must
be others. This requires a collective structure.” 11
To allow for multi-investments, it was necessary
to create conditions for liberty of circulation, a
possibility of expression—not necessary verbal—
but, also, a heterogeneity of people responsible
for the therapy as well as a diversity of “places of
existence.” However, this alone was not enough: it
is also necessary to engage actively in these activi-
ties. An analytical treatment of psychosis needed
the patient to take on an active role. So instead
of patients being removed from the tasks of daily
life or retreating into passive roles implied by the
doctor–patient hierarchical status, the approach of
institutional analysis was based on the core princi-
ple that patients should take responsibility for their
existence. This reconnection with daily life from an
existential-ethical perspective involved, as a conse-
quence, a collective participation in the definition
and organisation of the concrete institution.

11. Oury, Jean. “Psychanalyse,

psychiatrie et psychothérapie
institutionnelles.” VST – Vie sociale
et traitements 95, no. 3, 2007,
pp. 110–25.

Can an Institution be Militant? 125

 The Grid

In this context, one of the organisational devices,

the grid, was an experimental protocol, aimed at
expanding the therapeutic potential of the insti-
tutional spaces, in its social and environmental
dimensions. Succinctly, it was a rotating schedule
of tasks and activities, which ensured accountability,
experimentation with different types of activities
and functions (depending on the concrete needs)
and spaces, and also engagement by people with
concrete tasks. It involved both staff and patients.
The institutional space was understood not merely
as a container of social relationships, but as an active
agent, allowing for a heterogeneity of encounters of
diverse kinds, but also making it possible to avoid
rigid identifications or fixations. As Oury explained:
“This is all the more important as schizophrenics can
‘hold’ to everyday life like characters. He works a bit
in the kitchen, so he thinks he is the cook.” The grid
was a socio-environmental device.
A sample grid from the 1960s, published in a
special issue of Recherches,12 shows the following:
the names of people rotating on one side and the
amounts of time each person would spend on each
task or activity per week on the other side. It is
composed of two axes: a vertical axis with a list of
the names of the people in charge of specific tasks
or activities and a horizontal axis to measure time,

12. See “Histoires de La Borde” in the institutionnelle à la clinique de

special issue of Recherches titled Cour-Cheverny 1953–63, written by
La Borde: 10 ans de psychothérapie researchers of CERFI.

126 Susana Caló

from 8 a.m to 9 p.m. Tasks comprise things such
as dishwashing, house-cleaning, kitchen and night
shift duties, waiting at table, etc. Activities comprise
things such as the clubs, the journal, or the laundry.
Tasks (associated with “disagreeability”) are distrib-
uted among people according to a rota system.
These tasks ensure the minimal daily functioning
of the clinic and thus need to be shared by every-
one. The team managing the grid (the grilleuses) is
itself rotating. As a rule this team could not to be
composed of doctors, under the assumption that
what was to be avoided was that the distribution
of labour and the organisation of the clinic would
revolve around the medical structure. In the text “La
Grille,” Guattari refers to the grid as an “articulatory
system” whose goal was “rendering articulable the
work’s organi sation with subjective dimensions,
so as to allow for certain things to come into the
daylight, to allow certain surfaces of inscription to
exist.”13
The grid made it possible to make evident social
and environmental feedback effects that concerned
the whole of the institution. For example, it showed
how the laundry was a popular space. So was the
kitchen (less unsurprisingly): “The kitchen then
becomes a little opera scene: in it people talk, dance
and play with all kinds of instruments, with water
and fire, dough and dustbins, relations of prestige
and submission. As a place for the preparation of
food, it is the centre of exchange of material and

13. Guattari, Felix. “La ‘Grille’.” Chimères

34, 1998, pp. 7–20, at p. 12.

Can an Institution be Militant? 127

 indicative fluxes and prestations of every kind.”14
From the perspective of institutional analysis,
this apparently unimportant aspect could open
a window into something else—something that
would otherwise go unnoticed. At the same time, as
an organisational protocol it made power relations
visible—in particular, all those aspects left outside the
traditional doctor–patient relation. It also brought to
the forefront relationships existing in the background:
the institutional context, its constraints, organisation,
specific practices, and so on. Each institutional event,
material or immaterial, discursive or non-discursive,
was given conditions of expression. It is in this view
that institutional analysis was fundamentally collec-
tive. This was not just because, in its strict meaning,
analysis was no longer a privilege of the therapist
only, but was collectivised—i.e. it took place collec-
tively (in group sessions, discussion, etc.). Rather,
analysis was collective because it took place within
social and environmental dispositions, linguistic,
and signifying dimensions, technical, economic,
and sociological factors, rather than purely personal,
individual dispositions.
Any institution is a place of affective, social—but
also spatial and material—exchanges. It is in this
sense that a semiotic approach is relevant, since
it makes it possible to identify relations that are
normally relegated to a secondary plane. But here

14. Guattari, Félix. Chaosmosis:

An Ethico-Aesthetic Paradigm.
Bloomington: Indiana University
Press, 1992, p. 69.

128 Susana Caló

we must distinguish two important aspects: on the
one hand, we refer to significant semiotics—such
as written or spoken language, gestures, graphics,
symbolic play, and so on—but, on the other hand,
we also refer to a-signifying semiotics. These can be
understood in a double meaning: the first is regard
to the a-significant functions of the communicative
processes; the second, in regard to a-significant
semiotics, such as spatial rhythms, textures, colors,
temperatures of certain spaces. If the polyphony of
modes of expression explored in La Borde suggests
the importance of working with significant semi-
otics beyond language, the creation of mechanisms
such as the grid, functioning as a sensor of affective
investments—between people, spaces, activities,
etc., suggests the importance of working in a broader
semiotic dimension, which we would call environ-
mental. Analysis should therefore be understood as
an active interventional socio-environmental practice,
and not simply as a detached observation.

Collective Militant Analysis

While in English, the word “institution” conveys

forms of social organisation that are close to state
institutions, or similarly formal organisations, in
French the term “institution” refers to any form of

15. This particular aspect has been Semiotics and Institutional

developed in my research with Programming.” Lugar Comum 53,
Godofredo Pereira. See “Collective 2018, pp. 96–103.
Equipment. Environmental

Can an Institution be Militant? 129

 social formation, as well as to that which is “insti-
tuted” and therefore to the act of “instituting.” This
helps us to understand how the lessons and princi-
ples of institutional analysis might be relevant today.
To be concerned with the precarisation of collective
life in contemporary cities is to be concerned with
the institutional processes that led to this, such as
forms of work, the ways in which cities are designed,
the types of collective practices and spaces that are
available, etc., and therefore with the effects on our
mental health; as well as with the resulting conse-
quences for the types of social relations we establish
among ourselves and the world we inhabit. It is to be
concerned with care.
The key spaces where alternative models are being
tested today are those of third-sector organisations
exploring different models of being together, of
therapeutic communities, of social movements and
popular organisations working on intergenerational
relations, of community- and citizen-led projects.
These are the spaces where the most interesting
forms of mental health militancy are currently being
explored and implemented. Which is not to say that
they are not riddled with problems and difficulties.
In particular, the socio-environmental dimension
of institutional programming is something that
remains poorly understood, mostly due to disciplinary
structures that keep humanities and environments
in distinct contained fields of expertise. Precisely
because of this, we still have a lot to learn from insti-
tutional analysis and programming. Interrogating the
value of institutional analysis today, and speculating
about its possible mutations and forms beyond the

130 Susana Caló

hospital to a broader social scale, is key. Quoting from
Guattari: “subjectivity becomes collective—which is
not to say it becomes exclusively social. The term
‘collective’ should be understood here in the sense of
a multiplicity which is deployed both beyond the indi-
vidual, on the side of the socius, as well as beyond the
person, on the side of pre-verbal intensities […].”16
But the collective can never be given, but must
always be made: the collective, therapy and care are
to be practised, to be constructed, continuously. It
is these practices, which we can call institutional
analysis—where analysis is intervention—that are
urgently needed today.
I think we can start to re-assess what institutional
militancy might mean. It will certainly depend on the
practice of listening and talking, of the creation of
polyphonic and plurisemiotic possibilities beyond
speech expression, of aesthetic modes of exchange,
of management and organisation as empowerment,
and on transversality between the representational
and the subjective. Less interpretation, more analysis.

16. Ibid., p. 7, 9.

Can an Institution be Militant? 131