Staging the Clinic
François Pain’s Modes of Escape
Rosie Stockton
François Pain, Psychiatry Is What Psychiatrists Do
JOAN, Los Angeles
On view February 21–May 17, 2025
Anyone who has been heartbroken knows that loss can lead even the most solidly neurotic subject to the borders of psychosis. Reality breaks with the heart. So opens French artist François Pain’s short film, The Green Notebook (1980), written by Félix Guattari, as the camera follows our protagonist’s descent into madness. He steps out of the door of an apartment, followed by the shouts of his ending relationship ringing out into the street: “Fed up!!! . . . It’s enough now, it’s over!” As soon as he crosses the threshold from the home to the street, he begins to unravel. Evicted from the bounds of his relationship, with nowhere to go, he wanders aimlessly, makes incoherent phone calls, fumbles transactions, forgets what he is shopping for. A voiceover narrates his paranoid existential spiral as he processes his decision to leave: “At least everything’s clear now.” Letting the newspaper Libération scatter in the wind, each failed action indicates his rapidly heightening foreclosure from social norms and triggers memories, hypothesis, and plans of what caused the failed relationship (his lover’s feelings for another man) and what to do next.
Soon, his inner monologue fixates on a metonymic lost object: a green notebook he left behind in the apartment. The image on the screen is overlaid with the gridded lines of graphic paper, and Guattari’s own cursive handwriting appears superimposed over the frame. The narrator experiences a relational catastrophe that induces a psychic one, throwing him into a chaos that trembles ambivalently against the organizing intentions of the grid. According to Freud, the lost object is key in the constitution of the desiring, neurotic subject. First one loses the partial object of the mother’s breast, and then the mother herself. For Lacan, this initiates one’s entrance into the symbolic order: as a castrated subject. Yet, for subjects experiencing psychosis, loss can trigger a foreclosure of the symbolic: a break with reality. In the throes of failed love, our meandering Guattarian subject experiences a deterritorialization—his life and self as he knew them have both been shattered. Finally, as he wanders through an abandoned building, a voiceover concludes: “You can’t go on like this. You have to move something.” The film ends with an excruciating line of flight: he runs down train tracks, his silhouette dissolving into white light at the end of a tunnel. Neither lost object—the notebook, or the girlfriend—is recovered.
The Green Notebook is on view in Psychiatry is what Psychiatrists do, François Pain’s first solo institutional exhibition in the United States, at JOAN, Los Angeles. Curated by Perwana Nazif, the film plays alongside two other films by Pain: an early experimental film Pain shot in collaboration with patients at the La Borde Clinic, The Crystal Wave (1985), and a new video installation, Institutional Psychotherapy as One of the Fine Arts . . . (2025). Pain’s films largely address the historically specific triggers of madness: war, and the effects of fascism and colonialism on the psyche of the modern subject. Together, the three films portray a constellation of theorists and practitioners who co-created an experimental approach to treating madness in the wake of the war: Institutional Psychotherapy. In the booklet accompanying the exhibition, published by Semiotext(e), Everybody Wants to Be A Fascist: Institutional Psychotherapy as a Resistance Movement by François Pain, Nazif defines Institutional Psychotherapy as “a cultural revolution and antifascist resistance movement that aimed to cure the hospital itself.” Its most well-known practitioners included SaintAlban’s exiled Catalan militant psychiatrist, Francesc Tosquelles (who later became Pain’s analyst); Jean Oury, a student of Lacan and founder of La Borde; Félix Guattari, Pain’s friend and collaborator, and proponent of the famous schizoanalysis; decolonial theorist and psychiatrist Frantz Fanon, who worked with the Algerian National Liberation Front (FLN) at the Blida Psychiatric Hospital in Algeria; and Fernand Deligny, a reclusive writer, psychiatrist, and filmmaker who worked primarily with non-speaking autistic children. Tosquelles, Oury, and Guattari—whom Nazif refers to as “TOG”—laid the conceptual and practical ground for Pain’s video work, and all appear in Pain’s video installation produced for the show, Institutional Psychotherapy as One of the Fine Arts . . . (2025). The film, consisting of nine screens, opens bluntly with text on the central screen: “A history that begins with wars,” before fading into an interview with Tosquelles, director of Saint-Alban Hospital from 1940 to 1962, surrounded by archival clips of soldiers in battle, scenes from Pain’s other films, and footage from anti-war demonstrations.
Institutional Psychotherapy was practiced at both La Borde and Saint-Alban—the stages upon which Pain’s films unfold—where psychiatrists, artists, and militants lived and worked among patients in the midst of their treatment. Drawing from both Marxist and Lacanian traditions, Institutional Psychotherapy understood psychotics to have undergone a double alienation: a social state of being isolated and estranged from dominant norms and social relationships, and also a psychic state of being mad or insane, alienated from one’s own body schema. Under fascism, the personal crisis collides with a historical catastrophe of war. Whether it is the trauma of war or the trauma of the romantic breakup, the psychotic episode is triggered by an existential break from the symbolic order that renders oneself incoherent to oneself. The paranoia and delusions triggered by these types of macro- and micro-catastrophes are something psychiatry has always tried to tame. But Institutional Psychotherapy diagnoses the social state of crisis as what is mad, rather than solely the patient.
Developed in the wake of the German occupation of France and the Vichy regime’s “soft extermination”[1] policy toward people housed in psychiatric institutions, Institutional Psychotherapy was an explicit response to impacts of war and fascism on both the individual’s psyche and the institutions meant to treat people suffering from allegedly untreatable psychosis. Distinct from antipsychiatry’s dismissal of the institutional wholesale, Institutional Psychotherapy repurposed the infrastructure of the institution. Yet, as Tosquelles put it, the risk of setting up any institution was the danger of le toutpouvoir (the all-power), or concentrationism—and so daily life at La Borde was determined by a constant negotiation of tasks, work, hierarchy, and rules. The walls between the institution and the town were porous, and the patients were entrusted with what Tosquelles called “the right to wander.” Concentrationism, of course, was a key feature of fascism: the static consolidation of power toward one way of being with one sovereign ruler. Concentrationism had not only political effects, but also psychic ones, and Institutional Psychotherapy needed to take into account this connection between the political and the psychic and recognize how concentrationism developed in the mind. Therapeutic practices at La Borde set up what Oury described as “mechanisms to fight, every day, against all that could turn the whole collective toward a concentrationist or segregationist structure” both in the minds of the patients, but also in the social life of the hospital itself.
Despite Institutional Psychotherapy’s ambivalent relationship to Jacques Lacan, his intervention into Freud’s belief that psychotics could not be treated by psychoanalysis influenced the methods of treatment. Lacan defined psychosis as the foreclosure of the symbolic order: the domain of the signifier and of alterity. The neurotic subject of psychoanalysis deals with the fundamental lack that structures the symbolic order through repression, and the goal of the analyst is to help the analysand come to terms with her symptoms through transference, slips, and dreams. In psychosis, the subject never affirms the existence of the Name of the Father which organizes the symbolic order in the first place: there is nothing to repress and it is not registered in the subject’s symbolic universe. The foreclosure of the signifier of the Name of the Father leaves a hole in the Other. The psychotic’s relation to the Name of the Father is incoherent, and reality as established by the symbolic order cannot proceed consensually, but rather is expressed in symptoms such as paranoia and delusions.
This radical disorganization of the symbolic is painful and isolating for the patient, leaving them unable to engage in basic social relations. On these grounds, Freud dismissed the psychotic as unable to experience transference. But as practitioners of Institutional Psychotherapy discovered, psychotics did in fact experience transferential relations, but they were not expressed in an intersubjective dyad, they were collective and constellatory. But as Camille Robcis delineates in her book Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France, Institutional Psychotherapy begged to differ. As seen in the social life at La Borde and Saint-Alban, she writes, “Tosquelles referred to the psychotic transference as a ‘burst transference’ (transfert éclaté); Oury as a ‘transferential constellation’; Félix Guattari as a ‘transversality.’” These ideas of transference challenged the normalizing tendency of the Freudian cure: to make the neurotic more adapted to the symbolic order she lives in. Instead, the collective nature of psychotic transference challenges the sovereignty of the big Other who organizes the symbolic order as such: the doctor, the hospital, the fascist regimes. According to Oury, this constellatory transference opened up the possibility of a group subject with radical revolutionary potential.
“But as practitioners of Institutional Psychotherapy discovered, psychotics did in fact experience transferential relations, but they were not expressed in an intersubjective dyad, they were collective and constellatory.”
Institutional Psychotherapy provided a social stage for this constellatory transference to take place. As we see in Pain’s films, in the treatment of psychosis, the delusion must not be dismantled to find out what it “really means,” rather it must be supported on its own terms. The delusion becomes the means by which the psychotic covers the hole in the other, and the psychiatrist’s (and the community at the hospital’s) duty is to reduce the suffering of the psychotic by entering the logic of the delusion alongside them. The psychotic subject’s foreclosure from the shared symbolic means the psychiatrists must take her delusions in their metonymic function, rather than their metaphoric function. Pain’s videography was a key tool for creating scenes where the metonymic avowal of delusion and collective transference are played out.
In Everybody Wants to Be a Fascist, urbanist and sociologist AbdouMaliq Simone writes about the methods the South Beach Psychiatric Center in Staten Island used in the 1970s and ’80s to treat patients experiencing psychosis using methods from Institutional Psychotherapy. The clinic was designed as a “performance space” where doctors created sets that allowed patients to engage and enact their delusions “at face value.” The goal of these “highly structured simulations” “was not to treat symptom as a metaphor to be relinquished or delusion as a self-protection racket,” Simone writes, “but rather as an opportunity to go further, to narrate a story that might include more elements and dimensions, one that might accord, for example, parts for other patients on the ward to play.” If a patient was experiencing or causing problems it was not considered the individual’s fault, but rather “expressive of a configuration of relational powers that needed to be engaged as the locus of intervention.” Similarly, Stefania Pandolfo recalls the work of the psychiatrist Abdellah Ziou Ziou, who ran the psychiatric hospital of Berrechid, in Casablanca, Morocco, from 1980–1986. In it, she discusses the techniques the psychiatrist had to employ in order to be receptive to the question of his patients’ experiences: “how to listen, how to make oneself hospitable to psychotic experience, an experience that is as such inaccessible to the rationalist and secular language that shapes the sensorium of psychiatry.” The psychotic symptom becomes a chance to reconfigure the social relations of power and hierarchy.
The methods at South Beach and Berrechid are precisely what takes place in Pain’s first film in the field of institutional psychotherapy, The Crystal Wave (1985), where the camera corroborates the staging of a play of a patient’s delusion, and provides a stage for a new, collaborative form of subjectivity with a disordering capacity in relation to the Name of the Father. In the opening scene of The Crystal Wave, two people drive away from La Borde, a rundown castle purchased by Jean Oury in 1953, which became one of the longest-standing psychiatric hospitals to practice Institutional Psychotherapy. As the car drives away, a man comes running down the road toward the hospital, arms waving wildly, shouting a warning that a crystal wave is coming from the next town over. Frantically attempting to mobilize the others who are lounging and sunbathing near the lawn, he warns of the incoming danger: “Everyone was swallowed up and can’t move. We need to find a solution!” Another man responds. “We must pose for posterity’s sake!” Rather than disregard the warnings of the madman, the patients of La Borde rise up to support the delusion. They take action.
At La Borde, in addition to traditional psychiatric techniques of treating schizophrenia, such as insulin therapy, collective support of patients’ delusions was facilitated to mediate this suffering. Patients, staff, and caretakers at La Borde acted in, wrote, and co-produced The Crystal Wave, which was produced during one of Pain’s film workshops at the hospital. The script was based on a story written by Fernand Deligny as part of a workshop he ran at La Borde during his time there in the 1960s. Pain first screened the film in 1988 as part of the annual congress of the Croix-Marine, the federation of the country’s psychiatric hospital clubs, as a way of showing the clinic’s activities through a film: not as a documentary, but as a collective work of art. As Hannah Zeavin writes in her essay “Liberated Frequencies: On the Media Histories of Institutional Psychotherapy,” media was central to Institutional Psychotherapy, “not just to the limit of the wall of the asylum, being ripped asunder, but outward, through dissemination.” In addition to Pain’s film work, Zeavin points our attention to his participation in radio projects such as Franco “Bifo” Berardi’s Radio Alice and Guattari’s and his own Radio Tomate in the 1970s and ’80s. Fanon wrote extensively about the use of radio in the FLN as a participatory medium, rather than one to simply disseminate information. Pain uses the camera in a similar way, involving patients in La Borde in the process of filming life at the institution. As John Kelsey puts it in “La Borde Plays Itself,” “The camera is a machinic participant in the schizoanalytic experiment. It plays along, it generates psychotherapeutic scenes.” Rather than documentaries about Institutional Psychotherapy, Kelsey writes, Pain’s films are “performances of schizoanalytic desire.” Here, the camera is not solely a tool of documentation, but one that mediates, organizes, and mobilizes collective relationships within the field. Pain’s camera helps facilitate a solidarity that avows the metonymic symptom of the mad with the aim of collectivizing the stabilization of a delusion. According to Berardi, in Pain’s films “the imagination manifests itself through gestures and forms, and the context is one of solidarity. The solidarity of the insane, the solidarity of foreigners, the solidarity of speakers of diverse and untranslatable languages: this is the solidarity that François went looking for.”
As the film progresses, life at La Borde is on display. Throughout, the camera cuts to an older patient who has been nominated as the lookout for the crystal wave, as he slowly traverses the seemingly infinite staircase to the top floor of the castle. Meanwhile, another patient runs around the grounds of La Borde to warn the others. He visits the kitchen where patients and staff prepare melons and salad for the others, the printing shop where people are preparing the hospital newsletter and flyers, the accounting office where patients slowly count change, the stables where patients ride horses, and an art workshop where patients are etching images into glass. He runs to warn those participating in a town hall meeting, who are discussing the intricate details of a plum pie made the previous day. He warns people making ceramics, the hospital bar where people are lounging, the barbershop, a painting class— all activities that make up the therapeutic work and life of the hospital. Once the watchman finally makes his way to the top of the castle he looks out the window before turning back to the camera with the existential declaration: “I can’t see anything, but I can see you.”
Above all, the film documents the humor that characterized life at La Borde. Throughout the film, there is often soft laughter that can be heard behind the sparse dialogue. It doesn’t matter whether the warning comes from within a delusion of the man who rouses the community to respond: delusions are taken as seriously as any other fantasy. Besides, if the crystal wave is interpreted metonymically, the whistleblower is right: the forces and mechanisms that encroach upon La Borde in order to set life in stone is the one true threat to life at the hospital, where the customs, philosophy, and treatment is grounded in an ethos of what Nazif calls “permanent reconstruction.”The medium of the camera is at once implicated as the crystal wave and as its mode of collective processing. For what is film if not capturing a moment in time to transcend its own ending: a pose in and of itself. We might interpret the demand to pose for posterity as a reckoning with one’s own moment in history, to prepare to live by the axiom of avowing the return of the foreclosed. Not to discover what is repressed, but to discover what is metonymically true in a symbolic world where the foreclosed Name of the Father is complicit with Fascist regimes.
“The medium of the camera is at once implicated as the crystal wave and as its mode of collective processing.”
In Pain’s new video installation, Institutional Psychotherapy as One of the Fine Arts . . . , scenes from The Crystal Wave also appear in rotation alongside eight other screens. Echoing the grid of The Green Notebook, the installation is composed of nine screens arranged in a 3 × 3 grid, playing various scenes that define the field of institutional psychotherapy: footage from daily life at Saint-Alban and La Borde hospitals, archival footage of battlefields, street protests, and political propaganda, as well as excerpted clips from Pain’s previous films. Interviews with Guattari, Oury, and Tosquelles occupy the center of the grid, with voiceovers emanating through the gallery. For the non-French speaker, the subtitles flow along the bottom screen, demanding the viewer’s attention and leaving the rest of the moving images to be absorbed peripherally. It is a disorienting inundation of information all at once: our attention is seduced in nine different directions as semiotic chains are disrupted, commented on, folded back on each other. The psychiatric hospital is on the same existential plane as the battlefield and the street protest. Yet the grid offers the comfort of organization: as the clips shift from screen to screen, the border of each remains unchallenged. In the wake of the crisis of The Crystal Wave, the question is provoked: is the camera a dangerous weapon, capable of freezing everyone and swallowing them up like the crystal wave, or can it be used against itself, as a mode of escape? This is the same question Institutional Psychotherapy asks of the institution.
As Guattari argues in his essay “Everybody Wants to Be a Fascist,” the defeat of class alienation via Marxist revolution would not be sufficient to, as it were, kill the fascist in your head. The neurotic subject’s investment in the Name of the Father preserved the possibility of fascism in the unconscious, and even tended toward it. Under fascism, Guattari—and Institutional Psychotherapy—was invested in shifting the focus of analytic work from the neurotic to the schizophrenic whose foreclosed relationship to the Name of the Father carried the possibility of initiating horizons of radical and collectivized subjectivity. In their famous book Anti-Oedipus: Capitalism and Schizophrenia, Gilles Deleuze and Guattari developed the theory of “schizoanalysis,” endowing the schizophrenic subject with revolutionary potential. While they were accused by many of romanticizing the suffering of the psychotic patient, Guattari’s work at La Borde testifies to how seriously he took the patients’ lived experience and psychic pain—from alienation, to delusions and paranoia, to anti-social despair. As Jackie Wang points out in “Stone of Madness,” Fanon maintained that “madness is not freedom, but freedom’s negation.”
The strained status of madness’ relation to freedom embodies the tension at the heart of Institutional Psychotherapy. The stakes of this tension are made clear in a letter from Tosquelles, printed in the show’s accompanying booklet, in which we confront a scene that registers the oftentimes difficult and conflicting calls psychiatrists had to make when a patient was in crisis. He recalls one example when Fanon was visiting the hospital from Algeria. Following insulin therapy, one of Fanon’s patients relapsed into suffering violent delusions triggered by a change in her room. Fanon’s impulse was to recommence the insulin treatment, while another nurse diagnosed the patient with “fake psychoses”[2] and advocated to remain with the patient in her delusional state until the psychosis abated. In this case, the patient “regained her footing” after 48 hours without undergoing intense insulin therapy again. Although such psychiatric crises are not depicted in Pain’s films, their specter underscores the forms of social life at La Borde that were specifically practiced to mediate such potential triggers. Yet despite their influence and collaboration, we might pause to consider different contexts in which Fanon and Tosquelles conducted their work to think about the tensions and implications of deferring medical—or more institutional forms—of treatment for violent bouts of suffering under drastically different registers of freedom: a post-war France and a French-colonized Algeria.
The archival images of war and protest that flash through the grid of screens in Institutional Psychotherapy as One of the Fine Arts . . . (2025) do not allow us to forget the political and social catastrophes that were the backdrop of Institutional Psychotherapy. At La Borde, madness was not reducible to a theoretical image of a free revolutionary subject. Instead, Pain’s films both enact and document the method to the madness and insist on the madness of the methods of Institutional Psychotherapy: methods whose fundamental goal was building and supporting the solidarity of the mad—the solidarity of the foreclosed. Pain’s videography was a key instrument in facilitating these commons of madness by creating the frame and scene for patients’ otherwise anti-social delusions and dreams, and to begin to receive, per Guattari, a “vision of itself from the outside.” In a clip that appears in Pain’s Institutional Psychotherapy as One of the Fine Arts . . . , Guattari lays in a rocking chair draped in a light-blue afghan discussing his theory and practice of Institutional Psychotherapy. He speaks directly to the camera—a stand-in, or perhaps a manifestation of—the analyst. Perhaps, he jokes, psychotic transference works best when the analyst, too, is a little mad.
[1] Max Lafont coined the term “L’extermination douce” to describe the lack of care that led to the starvation and death of institutionalized psychiatric patients under the Vichy regime, as cited in Camille Robcis’ Disalienation: Politics, Philosophy, and Radical Psychiatry in Postwar France. Chicago: The University of Chicago Press, 2021.
[2] Frances Tosquelles, “Frantz Fanon and Institutional Psychotherapy.” Everybody Wants to Be a Fascist: Institutional Psychotherapy as a Resistance Movement by François Pain. Los Angeles: Semiotext(e), 2025, p. 34. As Tosquelles explains, the nurse believed, perhaps following the ideas of Ernst Kretschmer, that patients otherwise ready to leave the hospital would seem to relapse, though the symptoms “no longer corresponded to a biological constraint.”