Asylum

A few weeks ago, I stepped off the metro at Glacière in Paris’s 14th arrondisement and walked into Sainte Anne’s hospital, where I had spent the better part of my fieldwork last year. It felt good to be back in a psychiatric hospital as an observer, not a patient.

Walking through the gate was just as striking as I remembered it. All of the sudden, the relentless frenetic hubbub of Paris is muffled by fifteen-foot stone walls. A few strides further in, and you feel like you’re in a country estate, replete with vines creeping around stone facades and wooden benches nestled in well-tended gardens.

As luck would have it, that day I had walked in on Sainte Anne’s one hundred and fiftieth birthday party. They had strung lines of balloons from the statute of Esquirol up to the second floor of one of the old wards. The courtyard was lined with black and white portraits of the staff of Sainte Anne’s, from psychiatrists to electricians, that seemed to announce the dignity of their work, their workplace, and—although they were not pictured—the people they worked on. A schedule of events announced that in the evening, there would be a Sainte Anne’s history quiz led by the “users” association. People mingled on the grass, eating cake and pastries and sipping champagne and providing fertile ground for the perennial game of guessing who is a patient and who is a doctor.

The latter group, at least, is on the whole proud of their institution. The psychiatrists I interviewed rarely failed to mention that it was at Sainte Anne’s that they created the first “voluntary” hospital wards in France, and that it was at Sainte Anne’s that they discovered the first neuroleptics which, if not providing anything close to a cure for psychosis, are still the gateway to recovery for millions of people worldwide.

While most of the doctors no longer dared to say as much, some of the nurses still clung to the idea of “asylum” in the pure sense: that, in a moment of crisis, we need to be taken out of our stressful lives and deposited somewhere calm and protected. “Where do the real malades go in the United States?” I mumble something about homeless, about nursing homes, about supported housing, and wonder about the answer myself. Wherever it is, it doesn’t have a deer park or courtyard fountains.

History has condemned institutions like this one. The moniker “psychiatric hospital”, as a long lineage of critics of which Michel Foucault is only the most notable, gives a medical veneer to a place whose primary purpose is to shut away the people society would rather have hidden. The best place for mental patients is “in the community”. Sainte Anne’s is the past and the new hospital Maison Blanche, a few subway stops away, is the future: a non-descript building indistinguishable from the apartment block next door, with just enough outdoor space to allow the patients a place to smoke and just enough insulation and mirrored glass that the neighbors will put up with it.

All you really need to know about Sainte Anne’s, and the system of huge hospitals of which it is a vestige, is how badly most of the people there want to leave. Accounts like Barbara Taylor’s The Last Asylum, which recounts her stint in one of Britain’s remaining Victorian hospitals and her sense of regret when it closed in the face of Thatcher’s budget cuts and the rise of the recovery movement, is an aberration. People voted against the hospitals with their feet. Any place that has to force half of its residents to be there is doing something wrong.

As one person in the ministry of health told me, “We’ve never had trouble getting patients to leave hospitals. It’s only psychiatrists who want to stay.” I have no doubt that it will be a good thing when Sainte Anne’s closes, its luxury real estate in the heart of Paris sold off, its patients shoved off into public housing, its psychoanalysts replaced with cognitive behavioral therapists, its wards transported to “ordinary”, non-specialist hospitals.

And yet, I still feel a bit wistful thinking that, once upon a time, when we had so little to offer the mentally ill in terms of treatment and care, we still thought that, at the very least, they belonged someplace beautiful.

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