‘Frantz Fanon, Psychiatry and Politics’: Book Review

In the year to March 2020, Black people were more than four times as likely as White people to be detained under the Mental Health Act in England and Wales. If you want the numbers, there were 321.7 detentions per 100,000 Black people, compared with 73.4 per 100,000 White people.^[1] This data does not include detentions under Section 136 that take place in non-healthcare settings, for example police cells and that is an important omission. The mental health charity, Mind, has been collecting evidence to fill that chasm, reporting that “Black people are 40% more likely to access treatment through a police or criminal justice route, less likely to receive psychological therapies, more likely to be compulsorily admitted for treatment, more likely to be on a medium or high secure ward and be more likely to be subject to seclusion or restraint.” ^[2]

These figures are appalling, but they do not surprise me. For several years during my psychiatric training, I was the junior doctor on-call in South London, assessing patients who had been detained by the police under Section 136. My colleagues and I saw many more detained Black people than White and White-appearing people. Since 2012, I have been part of Her Majesty’s First Tier Tribunal, an independent panel that has the power to discharge the detentions. Removing a person’s liberty, compelling someone to have treatment because their health or safety is at risk, or the safety of others is at risk, is a huge imposition on a person’s liberty and can be frightening and traumatic as well as potentially life-saving. I consider it a privilege to take part in the judicial scrutiny.

The legal framework for detention, The Mental Health Act 1983, is itself under independent scrutiny. The authors of the Independent Review of the Mental Health Act, which published its final report in 2018, write in their forward, “we intend to shift the balance of power between patients and professionals”. The reviewers explicitly sought to understand the “the disproportionate number of people from black and minority ethnicities detained under the act.” ^[3]

Ending racial discrimination and improving diversity in mental health services, making them truly inclusive, is seriously on the psychiatric agenda. One of the first actions by Adrian James, who began his four-year tenure as President of the Royal College of Psychiatrists in June 2020, was to set up a Race Equality Taskforce. In response to a Call for Action on Institutional Racism within Psychiatry sent to the President, James responded in an open letter, writing: “racism and discrimination have a devastating impact on those viewed as ‘other’ and that the impact is very much de-humanising. I also agree that there are persistent and pervasive inequalities in society that can result in members of the dominant group receiving daily benefits while others are disqualified, silenced, and attacked, or else rendered invisible. Like you, I believe that systemic racism is one of the great ills of modern society and that it leads to appalling and unfair outcomes. As such it must be rooted out, with no stone being left unturned.” ^[4] His statement contrasts starkly, with the conclusions of the government’s Commission on Race and Ethnic Disparities, which said in 2021, “Put simply we no longer see a Britain where the system is deliberately rigged against ethnic minorities.”^[5]

The Commission on Race and Ethnic Disparities assertion is also at odds with my clinical experiences, of seeing first-hand both the diagnoses and also detentions under legal frameworks, intersecting powerfully with class, race and migration. I wondered, therefore, what would a decolonised psychiatry look like? It is with this question in mind, that I read Franz Fanon, Psychiatry and Politics, which was published in 2017 by the Caribbean Philosophical Association, as part of their Creolising the Canon series.^[6]  This book is coauthored by Nigel C. Gibson, a leading Fanon scholar and Roberto Beneduce, a Turin-based psychotherapist caring for victims of torture. Alice Cherki, who worked with Fanon as a psychoanalyst from his arrival in Algeria until his untimely death from leukaemia, and one of his last surviving colleagues, has written the forward.  All translations are by Lisa Damon. 

Before reading this book, I was aware of Fanon the philosopher, in particular his essay, Black Skin, White Masks, for which he is perhaps most well known, but didn’t know much about Fanon, the psychiatrist. This is in part because the writings in this volume were previously untranslated. Fanon was born in the French colony of Martinique, educated in France where he qualified in medicine, philosophy and psychiatry at the University of Lyon, served in the Free French Army and fought for the allied forces in WWII. It was then that he was appointed as director of a unique neuropsychiatric day hospital in Algeria, which had been declared part of metropolitan France.

I loved stumbling across many unexpected gems in this book, including the richness and breadth of Fanon’s thoughts on Freud and his changing stance towards psychoanalysis, his enchantment with Lacan and his conversations with Merleau-Ponty, with whom he took classes in philosophy. I learned that it was in Algeria, treating both French and Algerian soldiers, that Fanon began to describe the effects of what he termed colonial violence on the human spirit, ideas formulated in the war of Algerian liberation. As head of the psychiatric hospital, Fanon had the freedom to treat patients in creative, new, ways. For example, he prescribed art therapy, music therapy, installed football pitch and ran storytelling sessions. It was also during his work as a psychiatrist in Algeria that Fanon re-examined, through his perspective of being a Black man, the pernicious effects of racism, leading him to propose that some mental illnesses would be better understood as having social origins. Fanon described the complex interplay between genetic neurobiology and sociocultural and colonial injuries that causes mental distress. This critique of colonialism, Fanon’s political identification of the power asymmetry between doctors and patients as a pertinent factor in perpetuating mental distress and his urgent calls to therefore radically reform psychiatric services, are all the more persuasive knowing that he wrote and lectured on this while enacting exactly such a reform.

In the chapter, The Tunis Psychiatric Day Hospital, the value, benefits and limitations of day hospital mental health care are explored. Day hospitals are no longer radical or new models of care, but in Fanon’s time, the hospital in Tunis was the only day hospital outside Europe. Fanon’s damning observation that patients “were made into the enemies of the staff’s peace and quiet” feels chillingly contemporary. At the time of writing this review, nine members of staff in an NHS institution have been charged with the physical and psychological abuse of vulnerable mental health patients in their care.^[7] 

Fanon argues powerfully that the trauma of racism experienced by Black people is ignored by psychiatry, as it was practiced in Algeria, and that argument unfortunately also continues to resonate today. I would have loved to read more about Fanon’s insight into how this developed and specifically what interventions he took to stop it, but, unfortunately, there are very few of Fanon’s actual words on this. Instead, there is a précis of sociotherapy. As a clinician I wanted to understand how Fanon’s techniques differed from those in the “carceral and coercive environment” he sought to dismantle. I wanted more of “how” Fanon privileged his patients’ biographical narratives and less of “why”.

This brings me to my criticism of this otherwise excellent and academically rigorous compilation. Although there are several incredibly powerful chapters, notably Bitter Orange, the Consequences of Colonial War, in which Fanon’s authorial voice is clear and the quotations from his work brim with activist energy, other parts of this book lacks that luminosity. Notably, the chapters The Impossibility of Mental Health in a Colonial Society and Further Steps towards a Critical Ethnopsychiatry Sociotherapy, consist of well-referenced, yet sparse fragments, leaving the chapters’ central theses struggling under the weight of their meticulous endnotes. When I first opened this volume, I expected to find full translations of Fanon’s psychiatric writings. Translator Lisa Damon, in her explanatory note which comes at the end of the book, elucidates her difficulty: “Another difficulty stemmed from the fact that several of the texts are either unfinished articles, drafts for conference papers, or notes taken by a third person of a lecture given by Fanon.”^[8] Damon has provided some reconstructions, but has made the decision to “leave readers to pore over and grapple with the incompleteness, as if they were coming across them in French.”^[9]

The incompleteness meant some details of Fanon’s theory and practice of dismantling of unequal power structures were hard to reconstruct as a reader. Nevertheless, in the work that is translated and expertly introduced here, Fanon’s psychiatric practice, his identity as a doctor and his political activism are clearly intertwined and often indistinguishable. For postcolonial academics and mental-illness clinicians alike, Fanon’s psychiatric writings continue to offer a prescription for radical reform.

Dr Sabina Dosani is a third-year CHASE-funded PhD student in Creative and Critical Writing at UEA, where she is researching the language used by obstetricians and women writing about miscarriage. Sabina is a medical doctor and continues to practice psychiatry. She can be found on twitter @DrSabinaDosani.