Before Prozac arrived to alter the moods of millions, Maud Mannoni thought to delve with her emotionally disturbed and learning-impaired young patients into the meaning of the sadness and terror in their existence. The play, art, and talk of therapy were a means for these children to express themselves from the place of their distress and fear. Before schools started dispensing Ritalin daily so that children, many of whom live in households beleaguered by poverty, emotional chaos, violence, or alcohol, will pay attention to the teacher, Mannoni dared to undertake psychoanalysis with backward children and their parents, exploring the links between learning disorders and the child’s history within his or her family. How, she asked, does the child’s speech disorder, reading and math problems, or disorientation in space and time connect to his or her inner psychic-body reality? And, conversely, what role does the child’s “illness” or “deficiency” play for his or her parents and siblings, and how does that meaning rebound back on the child as the distorting mirror in which he or she struggles to sense who he or she is?

Reading Separation and Creativity: Refinding the Lost Language of Childhood stirs up a disturbing nostalgia. The boldness of Mannoni’s therapeutic experiments, especially at Bonneuil, where she founded a residential treatment institution for emotionally disturbed children, replete with theater experiments guided by the avant-garde director Jerzy Grotowski and storytelling by an African griot, might seem a mere throwback to 1968. Until one asks: Why does it seem a throwback? 

Over the past thirty years, psychiatry has steadily narrowed its scope, replacing psychotherapy with pharmacy prescriptions. Meanwhile, hundreds of therapies have bloomed within American culture, most of them guided by self-help prescriptions. Common wisdom has it that psychoanalysis has been rendered obsolete. I do not have the expertise to evaluate the validity or dangers of today’s most widely used psycho-pharmaceutical treatments, and certainly do not question the reality of clinical depression, but it is startlingly clear that the medical faith in benign smack and the social worker pill simply sets aside the notion that human beings have something to learn from the meaning of their terror or distraction, and that the transformation of their relation to themselves and others might require giving expression to that meaning. Can genetics, neurophysiology, and pharmacology really explain the psychosomatic complexity of human beings by bypassing the kind of selfquestioning and dialogue that are the hallmark of Mannoni’s psychoanalytic procedure?

That is the question one hopes the publication, in English, of Separation and Creativity might prompt American psychoanalysts, psychiatrists, and psychologists to seriously entertain. At issue is not how psychoanalysis might duel for prestige with popular treatments, but rather how it might rethink and actively pursue its relation to them.

I recently heard the French psychoanalyst Michel Tort make a penetrating, thoughtful criticism of the efforts that a young Lacanian analyst in the United States is making in treating children diagnosed with hyperactivity and attention deficit disorder (ADD). The analyst is genuinely alarmed at the tendency to treat these children with Ritalin instead of psychotherapy; she sees in this an externalization of the children’s disorders at the expense of fostering their capacity to articulate their distress and desire. Her presentation brought to light many common motifs she has discovered in her patients’ lives within their families and the bearing of that experience on their learning and behavioral problems. Tort, with great sympathy for the position she finds herself in, argued that it was a mistake to put the medical (or medicalized) approach to ADD and the psychoanalytic approach on the same plane, as though the analyst’s task were to make psychotherapy replace Ritalin or provide an analytic interpretation of ADD to rival the medical interpretation. 

Such an approach, Tort suggested, runs two risks. On the one hand, it unrealistically flies in the face of the simple fact that doctors and teachers will inevitably treat ADD with drugs and specialized education; on the other hand, and more significantly, in looking to replace the medical and educational approach, whether conceptually or in practice, the analyst in effect accepts the medical definition of what the disorder is. Tort suggested that, instead, the analyst must first preserve the specificity of psychoanalysis and recognize that its work must proceed at an oblique angle to the medical approach. Each case has to be analyzed on whatever terms the analyst can find, pulling on whatever threads of the child’s history and unconscious the analysis discloses. And, second, the analyst needs to make the medicalization of the child’s problems itself an object of analysis: what can the child discover in the analytic dialogue about what it means, within his or her own psychic reality, to be in the eyes of others the bearer of a symptom,” “illness,” or “deficiency” and to be treated with a mood-altering drug? The power of psychoanalysis lies in its specificity and even its limits. Its task is to expand the area of experience that can be articulated in the individual s own terms and own name, and therefore must leave open, case by case, how that project will mesh or not with the medical and educational goal of normalizing the child’s behavior. 

Confronting the uneasy relationship between psychoanalysis and the social aims of psychiatric and educational institutions was Maud Mannoni’s life work. In the school she founded at Bonneuil in 1969, the aims of psychotherapy were kept significantly separate from the other, no less essential needs of the patients. The art and theater studios were a protected space of creativity, supervised by the analysts and trainees, while the kitchen was the space in which the children could welcome “guests from the outside.” The “outside” world was also addressed through exchanges with other schools in letters, paintings, and a school paper, and the children had contact with “a variety of host families, artisans, and peasants in the area of Bonneuil.” Most significantly perhaps, the staff did not participate in the children’s schooling, which was carried out in correspondence courses: “In this way, the teacher who corrects and annotates their work is ‘elsewhere, and the adults at Bonneuil are there as companions to ease the enormous difficulties some of these children have.”

Life in the school revolved around two kinds of activities. On the one hand, the children participated through the morning Chat Time and other meetings in discussing rules and voicing complaints, managing the food budget, and regulating their own life together within the facility. And, on the other, the studios provided a secure space for the children’s creative activities: “we had to ensure the existence of a permanent frame within which free creative expression could take place, a frame that reflects the way human beings deal with aggressivity. If the frame is not maintained, the patient finds himself alone in his fantasy world, and when he suddenly loses the container for his anxiety, he acts out…. In each studio, the session opened with a mythic ritual serving to bring the children together. What they did after that was up to them. Speech can arise from a field of language, but not from a cacophony.”

The separation of the protected space of creative expression from the disciplined space of schooling, of psychotherapy from dealings with the “outside” world, of the children s provisional life together Within the institution from their social responsibilities in the community or at work, reflects Mannoni’s attentiveness to the two sides of her patients’ painful ordeal. On the one hand, they must find the means of expressing even their most stifled or destructive impulses, their most anti-social urges or most private fears, in an increasingly articulate form, that is, as an expression of themselves that can be shared with others without the risk of destroying the self or the other; and, on the other hand, they must develop their capacity to deal with real-world obligations and dangers without being defeated by the outside world’s perception of them as ill or retarded…. 

Download the Full Article