Falling, Dying Sheep, and the Divine: Notes on Thick Therapeutics in Peri-Urban Senegal

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Falling, Dying Sheep, and the Divine: Notes on Thick Therapeutics in Peri-Urban Senegal
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           1 3 Culture, Medicine, and Psychiatry An International Journal of Cross-Cultural Health Research ISSN 0165-005XVolume 43Number 4 Cult Med Psychiatry (2019) 43:663-685DOI 10.1007/s11013-019-09657-2 Falling, Dying Sheep, and the Divine:Notes on Thick Therapeutics in Peri-UrbanSenegal  Anne M. Lovell & Papa MamadouDiagne           1 3 Your article is protected by copyright andall rights are held exclusively by SpringerScience+Business Media, LLC, part ofSpringer Nature. This e-offprint is for personaluse only and shall not be self-archived inelectronic repositories. If you wish to self-archive your article, please use the acceptedmanuscript version for posting on your ownwebsite. You may further deposit the acceptedmanuscript version in any repository,provided it is only made publicly available 12months after official publication or later andprovided acknowledgement is given to thesrcinal source of publication and a link isinserted to the published article on Springer'swebsite. The link must be accompanied bythe following text: "The final publication isavailable at link.springer.com”.  ORIGINAL PAPER Falling, Dying Sheep, and the Divine: Notes on ThickTherapeutics in Peri-Urban Senegal Anne M. Lovell 1 • Papa Mamadou Diagne 2 Published online: 15 November 2019   Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract  Peri-urban Senegal lies outside the influence of both the nation’s historicpublic mental health model and contemporary global mental health. This paperexamines how cultural logics in this underserved region spill over from socialdomains to widen the therapeutic sphere of psychoses and epilepsy. Observationsand 60 carer and/or patient interviews concerning 36 patients afflicted by one orboth conditions illustrate how the ‘‘crisis of the uncanny’’, a spectacular eruption of psychoses and seizures into the everyday, triggers trajectories across these domains.To resolve the crisis, patients and carers mobilize debts and obligations of extendedkin and community, as well as a gift economy among strangers. The therapeutic andnon-therapeutic are further linked through the semantics of falling, which associatesthis local term for the crisis with divine ecstasy and the slide from human to non-human forms of life. We introduce the concept of thick therapeutics to capture howthe logics of sheep- other animal-human relationality, secular-divine politics of giving, and payment/sacrifice for healing imbue a therapeutic assemblage contin-ually constructed through actions of patients, carers and healers. We ask whatimplications therapeutic thickening might have for mental health futures, such asmonetized payment under global mental health. Keywords  Psychosis    Epilepsy    Eruption of the uncanny    Thick therapeutics   Senegal &  Anne M. Lovellanne.lovell@parisdescartes.frPapa Mamadou Diagnediapis2000@yahoo.fr 1 INSERM and CERMES (Research Center for Medicine, Health, Mental Health and Society) -UMR 8211, Paris, France 2 CERMES (Research Center for Medicine, Health, Mental Health and Society) - UMR 8211,Paris, France  1 3 Cult Med Psychiatry (2019) 43:663–685https://doi.org/10.1007/s11013-019-09657-2  Introduction ‘‘Faty gets medicine at the clinic, because epilepsy is in the brain’’. The elderly man,comfortably dressed in a boubou, and I 1 sit on plastic chairs beneath the baobab tree,surrounded by the tin-roofed structures of his family compound. It is shortly pastnoon, and the sweltering heat of this Senegalese desert town oppresses even in theshade. The community volunteer ( ba` jjenu gox)  who directed me here has alreadybriefed me on Faty’s affliction. Thanks to her, the man, Faty’s grandfather, has beenexpecting me, the researcher. For now, he is my sole interlocutor; Faty is off playingsoccer and his mother at the market.Faty’s seizures come and go. During his frequent falls, he hallucinates, becomesoddly agitated and folds himself into his mother. Seizures bring on skin conditionsso severe that ‘‘the boy’s head turns white’’. And though medication at first stoppedthe seizures, it ‘‘pumped up’’ Faty’s body into a grotesque shape. Even now,Gardenal (phenobarbital) can make him dizzy, agitated, or cause vomiting. Endlessvisits to renowned healers, and later the clinic, have consumed his mother’s hard-earned money from her food stand and his father’s remittances sent from his job inIvory Coast.Our chat is interrupted when the seven-year old boy arrives, energetic and allsmiles. A throng of kids in shorts and tee-shirts follows.The grandfather returns to our conversation: ‘‘Epilepsy is in the brain’’. But it is amarabout, he continues, his family’s spiritual guide, who finally clarified thedifficulty with the boy’s case. His intractable epilepsy,  the marabout   has told thegrandfather, stems from powerful  jinne  [demonic spirits] coming from India whopossess little children:The  jinne  were chased out of India, and they migrated to Senegal. Here theyintimidated dignitaries and adults – but in vain. That is when they turned tolittle children, leaving them handicapped … These  jinne  are the reason for theremarkable increase in seizures [ kiriss ] in Senegal today. And few healershave the knowledge to confront those  jinne . Those  jinne  have even knockedless experienced marabouts to the ground!Indian popular culture penetrated Senegal beginning in the 1950s (Vander Steene2008). But what matters here to the grandfather’s spiritual guide is the coupling of foreignness and indomitable force these demons exude. Only a great marabout canheal the severe epilepsy inflicted by powerful transnational Islamic spirits. Thegrandfather’s narration of his spiritual leader’s reasoning conveys a popularepidemiology of the incurability of convulsive epilepsy and severe mental disorders,echoed by patients, carers and sometimes health workers in areas like this one,untouched by either global mental health or Senegal’s own public mental healthmodel. And it metaphorizes fears of globalization more generally.This paper develops the notion of thick therapeutics to capture the complexityand contexts of trajectories such of patients like Faty, whose affliction is at once ‘‘in 1 ‘‘I’’ refers to P.M. Diagne, who conducted this interview. In this paper, ‘‘we’’ refers to A.M. Lovell andDiagne. All non-researcher names are aliases except for historical figures.664 Cult Med Psychiatry (2019) 43:663–685  1 3  the brain’’ and the work of malevolent intruders from India. The spectaculareruption of psychoses and seizures into the everyday, a phenomenon we term the‘‘crisis of the uncanny’’, links numerous material and symbolic domains. Like Fatyand his grandfather, patients and carers seek to resolve such crises by weavingbetween vernacular healing or what they call  faju Wolof  ; and vehicular Euro-American, imported treatment, or  faju toubab . To explain, tame, treat and containthe affliction at hand, their actions modify, refute and recombine a number of cultural logics underlying social forms beyond the strictly therapeutic. Reconfig-uring interpretative anthropology (Geertz 1973) within the practical normsperspective of French Africanist anthropology (Olivier de Sardan 2014), we applythe idea of thickness to crisscrossing interpretive contexts as well as to the shiftingways in which economic, social, political and other circumstances shape therapeu-tics through those contexts. Globalizing processes weigh directly on the therapeuticsdirected at the resolution of crises (e.g. through the flow of commodities like Faty’santi-seizure medication) and indirectly on social formations outside healingprocesses (e.g. through dispersal of family members like Faty’s father, a manuallaborer in Ivory Coast on whose remittances Faty’s treatments depend).Using observations and 60 interviews with patients and carers concerning 36patients in underserved peri-urban areas of Senegal, we focus on two social forms—animal-human-divine relationships and secular-divine gifts—whose underlyinglogics also affect the therapeutic realm. The semantics of ‘‘crisis’’ and ‘‘falling’’reinforces the associations that link these forms to healing, thus thickening thetherapeutics. Finally, we argue for the relevance of thick therapeutics for imaginingmental health futures where global mental health has yet to penetrate. At stake iswhether global mental health acknowledges or ignores the questions posed by thick therapeutics, including the extent to which components of vernacular healing canactually be extracted and made commensurable with the vehicular. Study Background, Theoretical and Methodological Considerations From Fann to Global Mental Health Post-Independence Senegal historically stood as an intellectual and cultural centerand exemplar of democracy for newly independent Francophone West Africannation-states (Cooper 2014). The Fann School, a unique ethno-psychiatric modelnamed after a neighborhood in Dakar, Senegal’s capital, sought to reconcile sociallyre-integrative values of indigenous healers with French clinical approaches toneurosis and psychopathology (Diagne and Lovell 2019). Founded in the 1950s by aFrench military doctor, Henri Collomb, Fann furthered France’s institutionalstrategy of maintaining ties to a decolonizing region. Fann’s proponents identifiedits ethno-psychiatric public health project as African-centered and disseminated itsprinciples to other Francophone African countries (Collignon 2015), althoughSenegalese psychiatrists and intellectuals eventually challenged the model’scolonial roots and culturalism (D’Almeida 1997). Despite the intellectual richnessof this illustrious but complicated past (Diagne 2015; Kilroy-Marac 2010), Fann- Cult Med Psychiatry (2019) 43:663–685 665  1 3
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