Revisiting Frantz Fanon: His Life and Legacy on Race, Colonization, and Psychiatry

The psychiatrist Frantz Fanon, best known for his works Black Skin, White Masks and The Wretched of the Earth, is a theorist famous for his impassioned writings on revolution and the psychological impacts of racial inequality and colonization. His writings have been touted by intellectuals from Jean Paul Sartre to Malcolm X and have inspired activists in the National Liberation Front, Black Panthers, and, more recently, the Black Lives Matter movement. Fanon's depictions of imperialist power are echoed by recent police killings of Black Americans, which have prompted public evaluation of privilege and culpability in perpetuating systemic racism. Within the field of psychiatry, there is renewed effort to explore how systemic racism affects our patients' lives and to confront the national racial injustices that permeate our institutional practice. With this new focus, Fanon's works merit revisiting because they are just as relevant today as they were 60 years ago.

Fanon was born July 20, 1925, in Fort-de-France, the capital of the Caribbean island of Martinique, at the time a French colony (1). Coming from a middle-class family, Fanon was afforded an education at the island's prestigious secondary school, Lycée Schoelcher. There he came to admire the poet and cofounder of the négritude movement, Aimé Césaire. In 1945, Césaire became mayor of Fort-de-France, with support from Fanon and the French communist party. Césaire wrote passionately on African identity and the existential torment evoked by slavery and colonialism. Fanon frequently referenced Césaire in his writings and embraced his uncompromising literary style.

After France was invaded by the Nazis in 1940, Martinique, which prior to the war had around 2,000 European residents, saw an influx of thousands of French sailors, who took control of the government, removing previously elected black officials (2). The occupying Vichy French regime exploited many of the resources of Martinique and, in conflict with the locals, unmasked themselves as oppressive racists. This only heightened Fanon's contempt for the injustices of colonial power (3). However, a global humanitarian at his core, at the age of 18, Fanon joined the Free French Army, the military force of the exiled French government attempting to regain control of Nazi-occupied France. In serving, Fanon was only further exposed to European racism and to the hypocrisy of allied forces, who, while proclaiming to fight for universal liberty, stratified their military forces into racial hierarchies. The hollowness of European ideals instilled in Fanon a skepticism that would remain throughout his career.

After the war, Fanon traveled to Lyon, France, to study literature, philosophy, and medicine. In 1951, he began his residency in psychiatry at Saint-Alban-sur-Limagnole under the mentorship of psychiatrists François Tosquelles and Jean Oury. There the three founded the institutional psychotherapy movement, a radical approach to mental health care that sought to transform the psychiatric hospital into a community. Under this model, patients—or rather "guests"—would have active roles in running the institution, with the aim of diminishing the inherent alienation of medical hierarchy. This is not to say that the hospital was bereft of medical treatment. Fanon, although a fervent social advocate, was also a practitioner of the emerging techniques in psychiatry, including electroconvulsive therapy and the novel neuroleptic, Largactil (chlorpromazine) (1).

In 1952, during residency, Fanon completed his seminal analysis of the psychological violence of racism, Black Skin, White Masks. Originally titled, "An Essay on the Disalienation of the Black," this stylistically provocative case study used literature, cinema, and philosophy of the time to illustrate the ontological crisis of Black consciousness in constant reference to White cultural standards (4). According to Fanon's theory, Blacks were denied phenomenological maturation because their everyday experience of the world was subject to what essentially amounted to a super-ego corrupted by White domination. White racism had instilled in the Black psyche an inferiority complex that, even in the struggle to overcome it, became an inescapable distortion of Black consciousness and identity. This "White gaze" pervaded all facets of life, especially discourse and culture, from the glorification of interracial romance, to the mastery of the French accent, to the prevailing psychoanalytic theories of the time, which proposed grand schemas that presumed a priori the privilege of Whiteness.

In 1953, after completing residency, Fanon moved to Algeria, which had developed a large dominant White settler population after France began conquering the country in 1830. There he became one of five directors of psychological services for the largest psychiatric hospital in North Africa, Blida-Joinville, which at the time treated over 2,000 patients. Fanon attempted to implement institutional psychotherapy practices at Blida-Joinville, but he struggled with integrating the divergent cultural backgrounds of staff and patients. These cultural tensions were amplified when only a year after he started his position, the Algerian War of Independence (1954–1962) broke out. Fanon became responsible for treating White soldiers fighting against Algerian independence, as well as Algerian revolutionaries struggling against colonial oppression, a burden that deeply troubled Fanon's conscience.

Fanon recognized the impact of racial discrepancies between staff and patients and conducted research on how race confounded psychiatric practice of the time. In one study, he examined the Thematic Apperception Test (TAT), a projective assessment that uses vague images to elicit patient's psychological schemas (5). Fanon found that the TAT failed to evaluate a number of Algerian Muslim women, which he attributed to a lack of external validity, because the projective images were rooted in Western culture. When shown images and asked to narrate, rather than free-associating stories rooted in unconscious mental frameworks, many subjects tended to describe images in a matter-of-fact way, simply listing features or objects. Fanon suggested that the images were uninterpretable for individuals whose lived experience made such pictures alien and unrelatable. This was one of many instances where Fanon brought light to the cultural insensitivities of psychiatric practice of the time.

Meanwhile, as French military interference in Algeria grew, Fanon's work as medical director became increasingly difficult. Hospital activities were defunded and often interrupted by military forces seeking members of the National Liberation Front or Front de libération nationale (FLN), the nationalist revolutionary force in Algeria (6). Frustrated with French occupation and fearful of arrest for secretly aiding the FLN, Fanon resigned from Blida-Joinville in 1956, claiming in a scathing letter that treatment was impossible in a systematically dehumanizing environment. Fanon went into exile and began working full-time for the FLN, both as a physician and as an editor for El Moudjahid, the movement's newspaper. Continuing to provide psychiatric care in Tunisia, Fanon encountered Algerian refugees and wrote case studies on their psychological traumas. These case studies would become a launching point for his final book, The Wretched of the Earth.

In The Wretched of the Earth, Fanon critiques the alienating imperialist power of colonization and lays out the dialectical progression for the colonized to achieve liberation. The book is also Fanon's most controversial work, because in the first chapter he argues that total decolonization cannot be attained without violence (7). Fanon saw violence as the only language colonizers truly understand. Through violence, imperialists instilled a sense of inferiority in the colonized, and it was therefore through violence that the colonized could regain a sense of self, a sense of culture, and the physical reality of statehood. From the privilege of ethical idealism, it is easy to criticize Fanon for his support of violence, much like Malcolm X was criticized; however, violence often seems less necessary to those not subjugated by it.

In his later life, Fanon became deeply involved in the Pan-Africanist movement, eventually becoming an anti-French Algerian emissary to Ghana and other African countries. It was in Ghana that Fanon was diagnosed with leukemia. He initially sought treatment in the Soviet Union and eventually the United States. In 1961, under the pseudonym "Ibrahim Fanon," Fanon passed away in Bethesda, Maryland. Shortly before his death, he dictated the last chapter of The Wretched of the Earth. His body was buried in Martyrs' Graveyard in El Taref Province in northeastern Algeria.

Although it has been almost 60 years since his death, Fanon's writings remain relevant for their insight into the ontological traumas of racial discrimination and the psychiatric consequences of race-based violence. From Fanon, we can also gain insight and recognize that we as psychiatrists have a responsibility to confront our methodology and examine how racial biases and discrimination weave themselves into our practice. Why is it that Black children are more likely to be given a diagnosis of conduct disorder (8)? Why is it that Black people with mental illness are more likely to utilize inpatient services than outpatient (9)? Fanon confronted these kinds of inequalities not only with idealistic writings but also with initiatives and experimentation, seeking to change clinical practice. Although the language we use to discuss these issues has changed since Fanon's time, his clinical writings are ultimately aimed at the same struggles we face today—recognizing where racism and oppression manifest themselves within our institutions and diminishing their deleterious effects on our patients' mental health.