TOWARDS A PSYCHOPATHOLOGY OF POVERTY by Angel Fiasché

Introduction by Mats Mogren

I

“You don’t like me, I go,” says the Argentine porteño in Spanish-accented English. With his unruly hair, short suede jacket, and cheeky boots, he gets up and leaves the room with surprising haste. We don’t understand. What’s happening?

I rush after him and ask. He only says, “You don’t like me! You don’t talk!”

In our very first meeting, we are confronted with cultural differences. Swedish silence meets Argentine–Southern Italian intensity. We are taken by surprise and feel slightly afraid. We—students at the Department of Psychology at the University of Gothenburg—are trained to be rational and academically controlled, not passionate. Gradually, however, we learn to handle these challenging cultural stereotypes, which simultaneously become a rich source of new knowledge and understanding, much to our delight.

In New York and in his hometown of Buenos Aires, he is accustomed to very different forms of student expression than the silence he encounters at the Department of Psychology at the University of Gothenburg in 1971. In those cultures, engagement is shown through discussion and, at times loudly and unsolicited, through interruption and the sharing of opinions. Silence is to “kill with indifference,” not to care: “What you’re saying isn’t even worth commenting on!”

A spectacular, confrontational opening that, over time, develops into a lifelong relationship with Sigmund Freud, Karl Marx—and, between us, into a deep friendship.

II

For a psychology student who is an FNL activist, a socialist, and a critic of behaviorism, encountering this Argentine—compatriot of Che Guevara—is balm for the soul.

At this time, Swedish psychoanalysts distinguished themselves by “apolitically” and coldly labeling the engagement of FNL activists as a “rebellion against the father” and a “teenage revolt.” Argentine psychoanalysts in the Plataforma and Documento groups, however, took a different position. They broke away from the Argentine Psychoanalytic Association (APA) and the International Psychoanalytic Association (IPA) for the same political reasons that led us to react against the “apolitical” stance—one that runs counter to the historical roots of psychoanalysis, most notably expressed in the engagement of the Berlin Clinic.

For us, the Argentines come to represent a psychoanalytic movement of its time—a psychoanalysis that takes a stand. And here comes to us a psychoanalyst who, while practicing classical “couch analysis” grounded in the same knowledge base, also devotes himself passionately to “no-couch” activism on the streets of New York. I can see this Argentine, Italian-descended Latino dancing through the ghetto—not in tango style, but in the style of West Side Story. Not a comfortable desk-bound analyst, but one who understands that changing only oneself is an illusion. The struggle for better and more humane environments requires social and individual awareness, shaped through the poor’s own lived experiences. These experiences are interpreted through the anti-colonial perspectives of Freud, Marx, and Fanon—class consciousness and individual awareness crystallized in “know thyself” as a prerequisite for human revolt.

Argentine psychoanalysis has, internationally—and especially in the Latin world—developed and radicalized essential parts of psychoanalytic theory and practice. It is perhaps best characterized by its ability to further develop and synthesize earlier lines of thought in a free and non-dogmatic manner. In practice, this means that the therapist should be able to move between different approaches depending on the patient they encounter and to choose methods based on the problem and the individual (Göteborg Psychotherapy Institute’s presentation).

This man sweeps into our lives and becomes our stalker; a guide to individually and culturally repressed forbidden zones, unknown and unconscious worlds. Into the realm where the powerful dynamic forces of passion and fantasy reign—hatred, envy, jealousy, love, desire, and greed; forces held in check by one’s own and the culture’s censorship. For those trained to “see” and equipped with knowledge, these are the driving forces behind the anxiety that manifests itself and is managed through symptoms.

Almost everyone in our group had worked within Swedish biological psychiatry, where psychological manifestations are claimed to be expressions of underlying bodily processes—a kind of machine psychiatry or “subjectless psychiatry,” as the professor of psychiatry Henrik Sjöbring called it. Then, as now, it was regarded as an ideal. Objectification in the spirit of the biological medical model is taken for granted and leads to dehumanization and medicalization. This model is now referred to as “neuropsychiatry.”

In the tradition we are now about to encounter, the patient is seen as a suffering human being with a personal history. But it does not stop there; this person is also understood within a given social context, which we must be familiar with because that context is also part of understanding the individual’s “difficulties.” The point of departure is: “How could it have come to be this way?” When, as in biologically oriented psychiatry, anxiety and other psychological symptoms are seen as grounded in chemistry and neurology, the human being is stripped of their humanity. And when—as in various forms of normative treatments—symptoms are seen as expressions of character flaws rather than the result of an unconscious survival strategy, blame and moralism easily follow. In the tradition to which we are now being introduced, all unconscious or conscious survival strategies the patient has “chosen” are respected.

The difference between our experiences of Swedish psychiatry and the perspectives we are now confronted with is vast. This approach opens up a new, more dynamic and exciting inner world.

III

The psychiatrist and psychoanalyst we encounter so dramatically is Dr. Angel Fiasché, who arrives in Gothenburg directly from New York’s Maimonides Hospital and the William Alanson White Institute, where he is a training analyst. At the age of nineteen, he had previously visited social-democratic Sweden, a country for which he has great affection.

He also leaves behind widely noted work as a “barefoot” mental health worker in New York’s ghettos—where large parts of the African American and Latino populations live—to become a lecturer in the newly established course in social work (Community Mental Health) at the University of Gothenburg. This program carried the intention of bringing together the professions of medicine, psychology, and social work. The course was an expression of one of the many radical initiatives of the time, which held that representations of human experience in the inner and outer worlds are “interwoven” with one another and, moreover, take shape in a variety of ways—psychological, social, and bodily. In addition, there was an ambition that the professions should work together in teams in less affluent residential areas in the suburbs of major cities.

Angel Fiasché’s experiences in New York made him the right person for the task. Despite the fact that the project there lost its financial support during Republican President Nixon’s administration, the core team (of which Angel was a member) nevertheless continued their work with the residents without pay. They financed the premises and the stencil duplicator themselves—tools that became central to both their own work and that of the residents. A newspaper and flyers announced the demands, analyses, and political positions of the large groups. The team became activists and action researchers.

Early on, they realized that they were regarded with suspicion by the ghetto population (as “white colonizers”), seen as having no other task than to pacify the population and pour oil on the waves of revolt. The group also realized—perhaps through their studies of the psychiatrist Frantz Fanon’s Marxist and psychoanalytic perspectives—that liberation had to be the work of the ghetto population itself.

What, then, could the group contribute beyond material resources? They realized that what they could offer was the question “Why?” They were enlightened academics with knowledge and, above all, a critical overview. They did not teach; they made knowledge available. The people themselves had to formulate the question, seek knowledge about it, and find the answer on their own. They developed their pedagogy in the spirit articulated by the Brazilian educator and literacy campaigner Paulo Freire, as well as by the French educator Célestin Freinet. They employed Socratic consciousness-raising questioning, which turns moralizing self-blame for being poor into a critical understanding of structural, oppressive, and poverty-producing forces.

Participants from the ghetto gradually ceased to see themselves through the eyes of the white man and consciously assumed responsibility for their insights (another contemporary revolutionary—considering the wild hair—who may also have been studied was the revolutionary Black Panther Angela Davis). Consciousness-raising precedes all change and liberation, which must be one’s own work, both socially and individually—the shared credo of Marxism and psychoanalysis!

Thus begin the dramatic turns of the “tango” we would dance for many years—with micro-revolutionary “steps” within institutions where power relations and the clinical approaches we increasingly question begin to give way. We are inspired toward anti-authoritarian struggle within institutions; toward the liberation of the psyche—politically, socially, and institutionally.

Our encounter with Angel Fiasché from Buenos Aires leaves such a deep impression that we students eventually establish our own independent educational institution with a clinic. The Gothenburg Psychotherapy Institute is founded in 1974, and the process we then initiate can in many respects be described as an Argentine “tango.” Our institute meant that, on Swedish soil, we created a new form of clinical work inspired by an international movement rooted in psychoanalysis, psychoanalytic psychiatry, existentialism, phenomenology, hermeneutics, critique of class society, and a commitment to the liberation struggles of colonized peoples and their lived experiences.

And this Argentine is our maestro. He leads the “dance” in a way that can be discerned in this book. The porteño from the port city of Buenos Aires suits our Gothenburg revolutionary working-class temperament perfectly. Here, a worker could come straight from the shipyard in a dirty work overall, lie down on the couch, and look inward at himself in relation to others. We like that.

Among the “workers of the psyche,” the message spreads—nationally as well—about a form of therapy other than the behaviorist, pedagogical practice that is largely dominant. Knowledge of the movement in the shipyard, ball-bearing, automobile, and port city of Gothenburg gradually begins to spread in all directions.

IV

Wonderfully spectacular, un-Swedishly improbable “episodes” accompany this maestro’s journey. With astonishment, Borås Tidning reports on the psychiatrist’s work at the Psychiatric Clinic of Borås Hospital, where Angel works as a medical intern (AT physician) and remains faithful to his social-psychological, non-dogmatically creative psychoanalytic practice.

It is worth noting that this medical intern from Borås, Sweden, was later in his career (in 1991) appointed Director Nacional de Salud Mental in Argentina—a position roughly equivalent to Sweden’s National Board of Health and Welfare. In that role, he sought to change the designation “psychiatry” to “mental health.” In other respects as well, he attempted to transform psychiatric institutions away from medicalized psychiatry. He drew inspiration from his visits in Europe to, among others, Franco Basaglia in Italy, Ronald D. Laing, and Joseph Berke in England (Angel touches on some of this in the present book).

For the time being, Angel works as an intern physician in order to support himself and to be able to remain with us during the years 1973 and 1974, giving continuity to the psychoanalytic studies we had begun at the university. The idea is that together we shall create the Gothenburg Psychotherapy Institute. We realize that we are only at the beginning of a long and demanding career of building knowledge and experience as clinicians. Angel is a necessary and essential prerequisite for what we plan to do: to create a clinical collective and an educational institute in the spirit of the Berlin Clinic. Only in collective form are we strong enough to carry out what we have decided to do. At one point, when someone in our group expresses a desire to pursue their own personal “box career,” Angel asks whether that person “wants to become the leader of mosquitoes rather than the lion’s tail.” Or, to motivate us collectivists with a clear quantitative and scientific argument: Two kilos of brain is more than one.

At the Borås psychiatric clinic, he practices his Argentine approach without restraint. The staff are astonished—and likely laugh and shake their heads at the mad Argentine doctor.

On one occasion, he simply sends home a diagnosed paranoid patient suffering from severe persecution anxiety. Angel, who works with the entire life situation and its human possibilities as his field of practice, discovers that the patient—who has a family and a house in a middle-class neighborhood—has been “flooded” with, to him, shameful and unacceptable homosexual fantasies. Faithful to his clinical habit, Angel carefully and phenomenologically enters the situation in concrete terms and gives the patient a direct and simple clinical recommendation. The staff are surprised and skeptical, shaped as they are by their internalized notions of “mental illness” and madness as interpreted through the biologically oriented medical model.

Quite straightforwardly, Angel sends the patient home with the “task” of telling his wife—and even his neighbors—about his fear of the consequences of being homosexual. The patient follows through and carries out the Argentine psychiatrist’s recommendation, and the anxiety recedes. The astonished staff observe the “magical” result with amazement and admiration. The intern physician Angel Fiasché becomes a story, a character in the clinic’s history.

His notoriety is probably shaped even more by another incident. Once again, Angel applies his clinical understanding and way of working in an everyday context, again within his area of specialization—psychotic states. Faced with this comical yet dramatic event, the staff likely laugh even more.

The incident consists of Angel accompanying a patient on a visit to a bank. Angel goes with him to the bank lobby where the patient is to attend to some business. Enter, then, a most mismatched pair: a rather frightening psychotic individual and a well-groomed, dark-haired Argentine. They attempt, in various confused ways, to explain their errand using gestures and extremely poor Spanish-English. The staff believe it to be an attempted robbery and call the police, who arrive with flashing lights and blaring sirens. At gunpoint, the presumed robbers are arrested. At the police station, the matter is eventually cleared up after a series of confused turns, and the police finally drive the “robber couple” back to the psychiatric clinic where they belong. Everything is reported to astonished residents of Borås in Borås Tidning, and the article likely gives rise to many smiles.

Not for a moment, however, should we believe that Angel is “careless” in his clinical engagement. On the contrary! In his own eyes, he is above all a clinician when he knowledgeably, courageously, and dynamically creatively explores the inspiring world of psychoanalytic concepts as working tools. He places great value on his well-attested craftsmanship as a “craftsman” of psychoanalysis.

Angel recounts that he has been left-handed since childhood and that he does not enjoy writing. As a child in a large family of Calabrian descent, it was inevitable that he would enthusiastically take part in the family’s many discussions. So he spoke. We experience all of this in the skillful construction of the clinical work at the Department of Psychology at the University of Gothenburg and at the Gothenburg Psychotherapy Institute. Carefully thought-out institutional programs for clinical work are developed: analysis of the encounter with the person seeking therapy; phenomenological description; the handshake; how the room is entered; the furnishing of the room; the in-depth interview; the case conference; analysis and careful selection of the therapist–patient pairing; ideas about transference and countertransference; countertransference as information; record-keeping; and reflections on termination work. Details, details, details…

The analysis of interventions is formulated using the Pichon-Rivière tradition’s concept of ECRO (in Spanish Esquema Conceptual Referencial y Operativo, translated into Swedish as KROS—Conceptual, Referential, and Operational Schema), which is aimed at change. Reflections on transference work follow Melanie Klein’s theories.

Dogmatic approaches such as “psychoanalysis for its own sake” do not appeal to us. We must understand why we do what we do—systematically and patiently, grounded in the relationship. A more than one-hundred-year-old clinically tested theory, constantly under clinical-theoretical development, guides us and serves as our primary working instrument. The word therapist has its etymological root in the Greek therapeutes—“servant,” one who acted at the theater stage—which finds its true meaning when we willingly place all our knowledge at the disposal of the patient—the “sufferer.” Together with them, we seek to understand the inexorable necessity of the chosen survival strategy, its history, and the fantasy representations of the threat that would be realized if this strategy could not be maintained. We also seek to understand how this unconscious choice prevents the person from fully utilizing their potential resources—that is, how psychic energy is diverted into defense/splitting instead of uncovering and addressing the dissolution of the dilemma and transforming it into a conscious conflict: to choose, resolve, and live.

Important to us is that the patient should not have to adapt to our method, nor that we should programmatically follow a “manual.” We do not choose the “patient.” We make the more difficult choice of finding one another—interpersonally and intersubjectively—in order to create a bond for the work.

Inspiration and ideas from the worlds of theater, literature, and film are natural points of reference. Angel is a cinephile and a lover of theater and often refers in his work to various stage representations—interestingly, for us Swedish cultural beings, frequently to Ingmar Bergman’s films, where we often find scenes that depict and clarify what we are investigating. Incidentally, Ingmar Bergman is very well known and appreciated in Buenos Aires!

The interviewee becomes a patient only after the case conference and the “signing” of the contract. Only then have I—within my therapeutic role—been entrusted with the task of fully using my therapeutic tools. We use psychoanalytic knowledge as a method of conflict resolution. We seek to reason about the symptom in dialectical terms of contradictions and dilemmas (that is, frozen conflicts); in terms of primary and secondary psychic contradictions; main and subsidiary ones.