Alice Bullard’s book focuses on one of the most crucial and compelling pages in the history of mental health in Senegal, namely the story of the Centre Hospitalier National Universitaire (CHNU) de Fann in the early post-independence years. The voices of patients and therapeutic specialists – whether biomedical practitioners, marabouts or local healers – are at the core of this book. Bullard shows the extensive repertoire of beliefs and healing practices about mental health in Senegal, which are described here amid the political, social and economic changes following independence. Much knowledge was produced at the Fann hospital and largely published in the renowned Psychopathologie Africaine journal between 1965 and 1975. A wide spectrum of clinical case studies is presented, offering readers a broad picture of individual stories, therapeutic paths, and medical treatments and activities implemented at the hospital. Alongside clinical case studies, the author taps into ethnographic findings and sociological insights. These materials are the result of research by the multidisciplinary and multilingual team at Fann, and they predominantly address the social dimensions of mental health and healing.
Bullard’s book is further enriched by diverse records from the colonial period, including official documents, reports by colonial authorities and doctors’ communications. Indeed, one of the greatest merits of this book is that it establishes a consistent comparison between the colonial era and the postcolonial period in relation to mental health care in Senegal. What emerges are the divergent approaches regarding suffering, therapies and treatment over time, as well as the stark contrast between clinical practices at the Fann hospital and asylum-based psychiatry, the latter marked by patients’ confinement and alienation.
Bullard embraces a neuroaffective perspective – namely, the polyvagal theory (PVT) elaborated by Stephen Porges, which is specifically evoked to review the Fann hospital’s case studies from the 1960s and 1970s. According to the author, PVT helps us go beyond the cranium-centric bias in the field of mental health and to focus on the interaction of the body and brain via the vagal nerve network (p. 49, digital version), while also emphasizing individual physiological regulation processes, including co-regulation and self-regulation.
The book is organized into nine chapters preceded by a contextual and theoretical introduction. Chapter 1 offers interesting glimpses into the life of the CHNU. This chapter revolves around the case of S.C., a Senegalese man consigned to the Fann hospital because he murdered someone he believed to be a sorcier anthropophage. This clinical story helps the author discuss the major orientations and innovations introduced at the hospital (including the inadequacy of Western nosographies, the importance of open-door settings, the presence of an accompagnant during hospitalization, and the role of communal meetings, also referred to as penc). It also highlights the gap between the colonial and postcolonial era in the history of mental health in Senegal. Chapter 2 describes PVT, the key framework adopted by the author in reading Fann cases and practices. Chapter 3 focuses on the clinical case of N’D., a Senegalese man who suffered from impotence, the origin of which was alternatively attributed to djinns, sorciers anthropophages and the practice of maraboutage. After presenting the diagnoses and clinical interpretations put forward by the Fann clinicians, Bullard adds her own PVT-based explanations. Chapter 4 traces the story of El Hadji Ba, a Fulani healer, presenting his healing practices and treatments. The chapter closes with a comparison between some aspects of El Hadji Ba’s therapeutic procedures and contemporary psychotherapy methods. Chapter 5 deals with witchcraft in Senegal, which is discussed in relation to the colonial period and the Fann team’s clinical and social interpretations. Chapter 6 brings together mental health, pregnancy, childbirth and children’s lives through a combination of case studies and ethnographic insights. Chapter 7 plunges into denial, dissociation and magical thinking, and PVT is evoked to read and interpret such phenomena. Chapter 8 examines the role of ancestors in the lives and suffering of the hospital’s patients, while Chapter 9 discusses a disorder that French psychiatrist Henri Collomb, the head of the CHNU between 1959 and 1978, referred to as bouffée délirante.
My main critique of the book is that the emphasis on neuroaffective sciences and PVT does not fully embrace readers who have no background in psychiatry or psychology. This focus may also be a bit opaque to the large number of historians, sociologists and anthropologists who have delved into the history of mental health care in Senegal and the experience of the Fann hospital. In addition, the internal structure of the book could have been improved; in my opinion, the chapters do not always follow one another with linearity, and a concluding section would have been useful to briefly recapitulate the most salient insights. Overall, however, Bullard’s book offers valuable insights into the history of mental health in Senegal, and points out the continuities and ruptures between the colonial and postcolonial periods in the field of psychiatry.
