To Our Friends in Therapy

We are very glad to republish this conversational essay, first appeared in English and in Castilian Spanish on kaaitheater.be, and in Italian on Not.

After completing a residency within the programme “How to Live and Work Now? In the Arts and Beyond” at Kaaitheater in Brussels in February 2021, we wrote this epistolary composition about our collaboration in an experimental and collaborative artistic research project on queer collective approaches to harm reduction and the act of gathering. The project began in 2020, with a first preparatory exercise between Talya Cholet and Alberto at Komplot art centre, also in Brussels. To put together this reflection, we departed from a series of questions that we received from Eva Decaesstecker from the press and communication office at Kaaitheater. To write this text, we held an email exchange for several weeks.

In the correspondence we share with you, after this introduction, we practiced an exercise in political, artistic, and discursive confluence and an essay on dissent. The purpose of this text is to begin a chain of questions that will help us to continue sharing knowledge among ourselves and with the people who worked alongside us the last six months, as well as with the future participants of this research project and those who read this text. The text does not seek conclusions; instead, through a conversational essay, it aims to participate in constructing a counternormative narrative that opposes the psychiatric and psychotherapeutic technologies of normalization and the biomedical and biopsychosocial hegemonic models of “mental health.”*

* (Until we find another more convenient expression, we will write “mental health” in quotation marks to express our doubts about this term’s use. Even if we were to accept the dichotomic general definition of health as the absence of disease, we would continue to assert that neither madness nor psychic suffering are diseases.)

From Brussels, Madrid and Paris we imagine, through a mad and critical “mental health” perspective, a new “mental health” harm reduction model. As a tool for building narratives that allow us in the future, within our queer communities, to desert the normality of the cis-straight, capitalist, colonial, and patriarchal system.

The work we have carried out until the publication of this text allowed us to begin weaving political and artistic alliances with various people. We want to thank them for their solidarity. Talya’s quote is excerpted from a series of conversations held in French during the first preparatory exercise for this project; those conversations were transcribed by Héloïse Prax-Jacques. We wrote this text in Spanish, and the collective Other Ways to Care was responsible for its translation into English. The text is illustrated with a portrait of us in Brussels during our residency time in Kaaitheater made by Loup Caccia. Joëlle Bacchetta made a portrait of Talya and Alberto that is not included here but was published by Komplot in 2020. Thanks also to Jon Rodríguez Forrest for reading the first draft of this text.

Alberto and Fátima
Brussels and Madrid, June 2021

Alberto lives in Brussels, he is an arts writer and administrator dedicated to collaborating in queer and counternormative processes for artistic creation, and is part of the queer arts initiative Buenos Tiempos, Int.

Fátima lives in Madrid and is an artist and a queer, antiracist and “mental health” activist, as well as one of the founders of Orgullo Loco (Mad Pride) Madrid.

Héloïse lives in Brussels and is a writer, performer, radio broadcaster, tarot reader and queer activist.

Joëlle lives in Brussels and is a writer and an artist interested in new strategies and ways of storytelling from a feminist and queer perspective.

Jon lives in Brussels and is an activist of the political left.

Loup lives in Brussels and is an image worker, photographer and video maker, and a queer, feminist and trans activist.

Other Ways to Care is a London-based collective that emerged from a desire to imagine alternative forms of care inspired by activist and collective practices that question, oppose and differentiate themselves from the neoliberal model and the increasing privatisation and individualisation of “mental health” care.

Talya lives in Paris and is a writer, queer activist and specialist in public healthcare projects.

Alberto

How did we both meet? 
…
In December last year, I had just completed a residency with Talya. We had carried out a preparatory exercise for our research project. I met Talya in 2011 in Marseille during the UEEH (Euro-Mediterranean Summer Universities of Homosexualities), a self-organised gathering of lesbian, gay, bisexual, trans, queer, intersex, asexual, non-binary, GSD (Gender and Sexually Diverse People) and feminist people that promotes the exchange, transmission and sharing of knowledge in a space for life and collective management. In the spring of last year, during the first period of lockdown in Europe after the outbreak of the covid 19 epidemic**, Talya and I spoke very frequently on the phone. I was in Athens and Talya in Amiens. In autumn of the same year, during our residence, which coincided with a second lockdown in Europe, we negotiated and imagined how to live together, survive, transform, and converge politically. 

** (Although it is more common to use the term “pandemic” to talk about covid 19, we have chosen to use “epidemic” in this text to highlight the uneven impact that this virus and the medical, legal, and policing measures to containing it have had and are having on people and communities of different class, gender, ethnicity, sexuality… within the same territory, and between different territories. We use covid 19 in lower case as a common noun that does not speak of a disease, but of a political and social collective experience.)

Weeks after my residency with Talya, I emailed you to invite you to participate in a second preparatory exercise for the same project, this time at Kaaitheater. I had followed through the internet the setting-up of Orgullo Loco Madrid in 2018, in which you participated. Your queer perspective of mad activism helped me access politicised narratives on my own psychic suffering and connect them with my participation, since 2009, in queer activism and arts, and other spaces where queer knowledges are shared.

You and I first met in 2008 in Madrid, and we would see each other from time to time at Nasti, a nightclub for “modernas” (fashionable fags) in the Malasaña neighbourhood. I think that the last time we met was at a public festival in Madrid in the summer of 2017 or 2018. Yet, we had not shared a politicised queer community space until we sought for it ourselves this February in Brussels.

I almost wrote a question here but, actually, I want to start by thanking you for the week we spent together in Brussels in February and handing over to you.

Fátima

Alberto, the one who has to say thank you is me, really. For me, it has been a turning point to collaborate in this project with you. To be able to gather, travel and move around in the context of the covid 19 epidemic, at a time in which meetings occur on Zoom, and when it is impossible even to meet with the people in the collectives we are part of. I would also like to thank you for facilitating bringing the discourse of Orgullo Loco Madrid beyond Spain. To transmit the violence that we suffer within the Spanish “mental health” system, the pathologization and the human rights violations in psychiatric practice to the sphere where this project is developed.

Years ago, when we were in Nasti having fun and not yet clear about our commitment to political militancy, I could not imagine that one day we would be lucky enough to have a space to collaborate. Especially a place that was safe, more so in these uncertain times.

Another thing I want to thank you for is that, because of this project, I resumed readings on queer activism, and could imagine, link, and associate the hegemonic idea of “mental health” in the biopsychosocial model, based on mental illness, in relation with the construction of gender binaries.

I would like to ask you the following questions. Do you think we could interpret (perform) psychic suffering to remove it from the bindings of biomedical and biopsychosocial hegemonic models? How could we do that?

Alberto

Today, when I think of my experience with the psychiatric and psychotherapeutic technologies, more precisely my experience of psychotherapy with a psychiatrist, I realise that I participated in a practice of normalisation, at least in part. It was an exercise of normalisation that gave me the tools to carry on with normal activities; activities to which society attaches a normality value.

“Would it be possible to claim a conversation about psychic suffering from a politicised and clearly situated position?”

In parallel to that psychotherapy, I was, and still am, in close contact with friends involved in queer thinking and activism. Together we were able to draw on our experiences of psychic suffering to question our very own internalised psychophobia***, and that which exists inside and outside our communities. These conversations have allowed me to develop a critical position from which to understand my experience of psychotherapy today as, among other things, an exercise in normalisation.

*** (I translate here from the French term “psychophobie,” which you and I used frequently during our residency in Brussels.)

This awareness is crucial for me to be able to question the technologies of psychotherapy and to take a critical stance regarding a process I have been part of. With this example, what I try to do is to show the importance of a politicised, partial, and invested perspective to understand the historical and political question of the construction of what is “mental health,” to be able to create thinking that dissents from psychiatry and psychotherapy normalizing technologies.

To answer to your question with more questions, I would say: Would it be possible to claim a conversation about psychic suffering from a politicised and clearly situated position? Further, how would it be possible to proliferate discourses away from the hegemonic biomedical and biopsychosocial models? How could we claim a forum for political exchange in which these hegemonic models of “mental health” are not the frames of reference? I think the Mad Pride movement is already busy with much of these reflections.

And now, having in mind our project in particular: How can we create spaces to talk about psychic suffering in our queer communities? Can we do so from a position of critique of psychiatric and psychotherapeutic technologies? And, while doing so, how can we move towards a model of mutual aid and collective learning and avoid moralization?

Fátima

I am very interested in every question you are raising, which place us in a space of situated understanding, which seems to me the most appropriate to start thinking about the questions you raise.

“but ‘the pain of the soul’ should not need to be placed in the area of healthcare, perhaps rather in social justice.”

But before moving on, I would like to draw your attention to a small nuance about the word “psychophobia,” which we used quite a lot during the week at Kaaitheather. Even the terms that try to go against the discrimination that psychiatrized people suffer may perpetuate what we are fighting against. If we consider psychophobia as oppression against psychiatrized people we may end up validating the existence of mental disorders, for instance, or by trying to equate it with other categories of oppression such as racism or homophobia. The problem is not that there are people who experience psychic suffering, this is something all people experience. The problem is how this psychic suffering is treated from the approach of psychiatry, which considers it a disease that requires putting a diagnostic label, medicalizing, submitting to involuntary admission, etc. I think it is interesting to mention the word “agateophobia,” meaning fear of madness. I find it amusing that even the fear of madness involves a diagnostic dimension… We need to find terms that do not perpetuate a system of mad and sane people, as if these were natural and fixed categories. In the end, he who decides you are a mad person is always a psychiatrist. There is, therefore, an asymmetry of power and rules about what is normative and what pathological.

Regarding the questions you ask, I think it is more than necessary to claim the importance of talking about psychic suffering with attention to all angles of analysis. In fact, part of the complexity of everything around madness is the variety and extent of fields of knowledge dedicated to its study: philosophy, anthropology, history, sociology, biology, economics, theology… It has been assumed that madness belongs to the field of medicine, but “the pain of the soul” should not need to be placed in the area of healthcare, perhaps rather in social justice.

To generate critical discourses, away from biomedical and biopsychosocial hegemonic models, I believe that we must, on the one hand, build solid discourses that break from those models in all forums where we have the opportunity to. And, on the other hand, we must generate a paradigm shift. In our collective, Orgullo Loco Madrid, we learn that raising our voice does not do much good if not accompanied by the rest of our comrades in struggle. By this, I mean queer, feminists, antiracists comrades, etc.

The good thing about there being little, is that everything is yet to be built. Regarding your last question on how to claim a forum for political exchange outside the benchmark of the hegemonic model, I dare to ask you: How could we do something like this first at a European level and then transcontinentally? Can a project like ours serve as a seed to build something of that sort? Do we lack models we can rely upon?

I believe the covid 19 epidemic has pushed all people to be more aware of our psychic distress; thus, this seems an excellent time to talk about psychic suffering in our queer communities from a critical perspective of “mental health.” Likewise, it appears to be a good moment to generate collective spaces of listening and mutual support, in which support is not only material but also care. It seems essential that these are spaces where every person can express how they feel without feeling judged, expelled, or abandoned to a psychiatric-psychological practice.

Equally, I believe that it is a good moment to understand in our queer communities that just as all related to sexuality and gender has been historically pathologized, the same occurs with psychic suffering and madness. For example, now in the Spanish state, we are fighting for a bill for trans people which includes demanding not pathologization nor psychiatrization. I believe it is important that in our pedagogy within queer communities we start considering why certain psychiatrizations are rejected and others allowed, and that we stop policing normality beyond gender. First let us begin to create safe spaces that are necessarily critical of psychiatrization, and gradually we will eliminate moral burdens, and we will surely begin to think about everything from perspectives we have not even imagined yet. To begin with: What are you already imagining, Alberto?

Alberto

Thank you very much for opening up our conversation to a multiplicity of crossovers between historical antipsychiatric thinking, contemporary mad thinking and queer thinking. I am going to try to answer to your questions about how to imagine our project, on what referents to base ourselves on, and how to create networks by delving into how we are trying to participate in the elaboration of languages for dissent and for the political confluence of people engaged in multiple tasks of creating counternormative discourses.

When you ask me, Fátima, about how to imagine our project, it seems important to tell the readers of this text that we are preparing gatherings of queer artists and activists with the intention of creating collective strategies of opposition to healthism (a system of oppression that considers health as the property and responsibility of the individual, and judges people according to their level of health or illness; a level that medicine and law are in charge of determining). And we do so from the recognition of the moralising and healthist turn that followed the eruption of the covid 19 epidemic in 2019 and 2020 and considering the political and artistic heritage that the queer community draws from the aids epidemic activism from the 1980s to the present day. To oppose healthism, in these gatherings we propose to think about risk reduction**** models, which are a set of practices used in queer and health activism and in public health campaigns that aim to reduce the possible negative impacts of a social behaviour without judgment.

**** (The term “risk reduction,” literally translated from the French term “réduction de risques,” will from this point of the text on be privileged over the more commonly used “harm reduction” to stress the aim to contest healthist concerns that precede a given social behaviour and provoke judgement and exclusion.)

Having spoken earlier about psychiatry and psychotherapy as technologies of normalisation, I continue by asking myself and by asking you: What are the risks of those non-normative social behaviours that are psychiatrized and/or whose modulation is claimed by psychotherapy? If, as the international Mad Pride movement is doing, we call for a re-signification of the term “madness,” what are the risks of madness?

Madness and psychic suffering, and its public and disobedient expression (as you rightly wrote: “the problem is not that there are people who experience psychic suffering, this is something all people experience. The problem is how this psychic suffering is treated”), entail clear legal risks (the case of the American singer and musician Britney Spears, who from 2008 until today lives under the medical and legal guardianship of her father after having been psychiatrized, is well known), medical risks (understanding psychiatrization as a risk and not as a “cure” or “treatment”), work-related risks, economic risks and sociability risks, among others. The modulation of these risks goes hand in hand with the systemic oppressions of machoism, racism, transphobia, homophobia, classism, etc. I have learned this from mad activist movements and their intersection with feminist, antiracist and queer struggles. But I want to ask: How do you imagine a new perspective on risk reduction created from within “mental health” activism? What interests might “mental health” activism have in creating this new perspective?

To think risk reduction within our queer communities leads me to a question that structures our project: Is it possible to devise a collective approach to risk? And by extension: how could we bring about changes in our communities to ensure, among others, the “right to madness” that you have been talking about in the Mad Pride movement?

It is possible that in the future, our project and its gatherings of queer artists and activists will bring us closer to answers for these questions or, perhaps, show us how to reformulate them. But for this, we need to create strategies “to claim a forum for political exchange outside the benchmark of the hegemonic model,” as you said earlier in this text. How to do this?

“Should we desert? And if we decide to desert, Fátima, how do we do it? And what do we desert from?”

I want to share here an idea that could help us imagine how to get out of hegemonic and healthist models, which comes from a conversation I had with Talya in 2020 during a preparatory exercise for this same project. Talya speaks about “deserting” as a disobedience and dissent strategy. In our conversation with Talya, speaking of prophylaxis and coronavirus transmission, she explains through her experience:

“Je fais des arrangements tous les jours entre la considération pour les multiples enjeux épidémiologiques – la transmission, la vulnérabilité, les oppressions qui se jouent autour de cette circulation de virus – et la considération de mes besoins qui participent à ma vie et qui sont manifestement plus essentiels que ce que l’opinion publique et les directives légales et réglementaires ne l’accordent. En ce sens la résistance est l’ambivalence qui est la plus difficile sur le plan politique. Pouvoir à la fois dire que cette crise révèle des inégalités systémiques criantes et violentes qui mettent en danger des personnes que la société a vulnérabilisée et que cet ordre sanitaire participe aussi à la destruction de nos vies. En tout cas à leur amoindirissement, leur inconsidération, leur illégitimité, leur caractère non essentiel. L’essentiel c’est la vie familiale hétérosexuelle. Ca ne me concerne pas. Ce n’est pas ça qui va me faire vibrer, vivre et exister. Je ne veux plus attendre d’être validée. Je ne veux pas me faire honneur de n’avoir pas attrapé ce virus comme preuve de légitimité dans cette société. Je le pose parce que j’ai vu notamment au travail qu’être en bonne santé et rester en bonne santé sont des termes extrêmement normatifs. Tomber malade c’est un peu ne pas être à la hauteur des enjeux. Je ne veux plus jouer sur ce terrain là. Je veux déserter toutes ces oppressions pour aller vers une manière d’être à moi-même.”

(I ponder every day, between considering multiple epidemiological aspects – the transmission, vulnerability, and oppressions that develop in the circulation of this virus – and considering my own needs, which are part of my life and more essential to me than public opinion, law and rules concede. In this sense, resistance is politically the most challenging ambivalence. Simultaneously, being able to say that this crisis reveals flagrant and violent systemic inequalities that put at risk those people that this society has made vulnerable, and that this healthcare order participates in the destruction of our lives. In any case, it contributes to the debilitation, inconsideration and illegitimation of our lives, and marks them as non-essential. The essential is heterosexual family life. That life has nothing to do with me; it is not what will make me vibrate, live, and exist. I do not want to wait any longer to be validated. I do not want to be proud of not having contracted this virus as a proof of legitimacy in this society. I say this because I have seen, particularly in the workplace, that being healthy and staying healthy are extremely normative terms. Getting sick is a bit like not being up to it. I no longer want to play on this ground. I want to desert all these oppressions to go towards a mode of being that is my own.)

Should we desert? And if we decide to desert, Fátima, how do we do it? And what do we desert from?

Fatima 

Alberto, I find it very interesting that you are asking me about imagining a new perspective of risk reduction models in the domain of “mental health,” and it is an idea that we, in “mental health” activism, are very interested in, since this approach has only been worked on in relation to addiction. I would like to explain that the risk reduction model in the area of addictions respects that a person freely decides whether to use drugs or not, and the focus is more on reducing the risk of an overdose or that the person lives in dignified conditions. I consider interesting a risk reduction approach in “mental health,” where the risk is situated in psychiatrization, and the reduction would consist in avoiding it and in avoiding a psychic distress that can often be solved with a bit of support or simply by covering the material needs of all people. I believe that this could be the starting point for the paradigm change that “mental health” requires.

“To imagine a collective response to risk, it would be good to incorporate into our demands the right to madness, which is closely linked to the right to be free from psychiatrization, the right to be free from diagnosis and from psychiatric violence of any kind.”

It seems to me that a good way to build this model is by not letting the pressures of everyday life be so stifling that they cause people to explode. If we could reduce risks at work, for example by changing certain situations or ensuring respect for the most basic labour rights, we could prevent stress and future crises for many people. In the same way, in the family context, if we could provide adolescents with other spaces, we would be able to reduce the risks of a crisis and its consequent psychiatrization. I insist that the best way to reduce the risk of psychiatrization would be to make it disappear. If there were crisis houses instead of asylums, it would not be so horrible to go mad.

You ask me what the greatest risks of madness are, and I think the greatest risk is precisely psychiatrization. In our society, any behaviour that is out of the norm or that we do not understand or that we do not like is considered an illness. We pathologize wrongdoing: when a person does something that we consider bad, we call them a psychopath. In the same way, when a behaviour does not fit in with what we consider to be appropriate, we pathologize it. We have rules for everything and if a person breaks them, we leave them out.

To imagine a collective response to risk, it would be good to incorporate into our demands the right to madness, which is closely linked to the right to be free from psychiatrization, the right to be free from diagnosis and from psychiatric violence of any kind. To bring about change in our communities and to secure this right we must eradicate both the fear and the concept of the dangerousness that has been linked to madness, as well as the deterministic concept of biology of mental illness. And last, but not least, we must engage in a lot of pedagogy that insists on a critical perspective on “mental health” and a paradigm shift.

Thinking about the future, on the strategies for reclaiming a forum for political exchange outside the hegemonic model and how to carry out those strategies, we should take several steps. First, to gather ourselves to generate training and pedagogies for more people to join us. Second, to weave networks, starting in our cities and gradually extending out of them. And third, to unite different movements and activisms. It is key to generate our own spaces, literature and art so that, being able to disseminate it, no person out there, more disconnected, feels alone and has nowhere to refer.

Regarding your invitation to desert, I think you and I, and Talya, of course, have been deserting for some time already. We deserted from the cis-straight and gender normative system, and we deserted from the psychiatrization that distinguishes the “ill” and the “sane.”

The only way out of a hegemonic model is on the margins of activism and by being able to gather among us; perhaps the only way to desert is to hold hands and refuse to follow the trend.

Deserting from a hegemonic model of normality in a capitalist, colonial and cis-straight patriarchal system seems to me to be the only possible way out. And, with all the people deserting with us, Alberto, creating our own disobedient army of resistance and mad, queer, and anticapitalistic militancy.

(Note on June 10, 2021. At this moment we are continuing our project with the support of a/r asbl art-recherche and erg école de recherche graphique, through a one-year research grant from the Fonds de la Recherche en Art (FRArt), part of the Fonds de la Recherche scientifique (F.R.S.-FNRS) in Belgium.)

Note on Supporters: November 15, 2021
This research project continues today with the support of a/r asbl art-recherche and erg école de recherche graphique, through a one-year research grant from the Fonds de la Recherche en Art (FRArt), part of the Fonds de la Recherche scientifique (F.R.S.-FNRS) in Belgium. Additional support for the project comes from Fédération Wallonie-Bruxelles and Goethe-Institut Brüssel, both in Belgium.