An Impossible Inheritance

Postcolonial Psychiatry and the Work of Memory in a West African Clinic

Katie Kilroy-Marac

• Publisher: University of California Press
• Year: 2019
• ISBN:
  9780520971691
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

Weaving sound historical research with rich ethnographic insight, An Impossible Inheritance tells the story of the emergence, disavowal, and afterlife of a distinctive project in transcultural psychiatry initiated at the Fann Psychiatric Clinic in Dakar, Senegal during the 1960s and 1970s. Today's clinic remains haunted by its past and Katie Kilroy-Marac brilliantly examines the complex forms of memory work undertaken by its affiliates over a sixty year period. Through stories such as that of the the ghost said to roam the clinic's halls, the mysterious death of a young doctor sometimes attributed to witchcraft, and the spirit possession ceremonies that may have taken place in Fann's courtyard, Kilroy-Marac argues that memory work is always an act of the imagination and a moral practice with unexpected temporal, affective, and political dimensions. By exploring how accounts about the Fann Psychiatric Clinic and its past speak to larger narratives of postcolonial and neoliberal transformation, An Impossible Inheritance examines the complex relationship between memory, history, and power within the institution and beyond.

ONE

Archiving Madness

FROM COLONIAL PSYCHIATRY TO THE ESTABLISHMENT OF FANN

LOOKING BACK, DR. JEAN RAINAUT REMEMBERS BEING horrified by the abject state of the hospital he had inherited. When the French military doctor became the director of l’Ambulance du Cap Manuel in Dakar in 1955, the place was no more than a miserable, prison-like, racially segregated dumping ground. Reflecting upon his experiences at Cap Manuel some twenty-five years later, Rainaut (1981: 431) still had not forgotten its awfulness; he carried with him the image of the “cage into which a number of nearly naked men and women were crowded, deprived of all outside contact,” not to mention his memory of the suffering endured by the patients themselves.

In his recollections of Cap Manuel during the 1950s, Rainaut comes across as a sympathetic character. He paints a picture of himself as having been sensitive to issues of abuse and injustice as he highlights the strong objections he had to the dehumanizing conditions of the colonial hospital. Far from being an anticolonial radical, however, Rainaut might better be described as a colonial liberal, eager to implement reforms from the inside. And were it not for the fact that his 1981 testimony recalling the horrors of Cap Manuel quickly evolves into a heroic tale of overseeing its closure in 1956 and leading its patients to the newly built, state-of-the-art Fann Psychiatric Clinic, Rainaut’s grim recollections of the place might have allowed him to cast himself as victim, in a role similar to that of what medical anthropologist Allan Young (2007: 156–57) describes as a “self-traumatized perpetrator,” or in other words, one who “has been traumatized by the effects of his own violence” during a time when he himself was not a “morally autonomous agent” (158). Rainaut, as part of the colonial apparatus, might have scripted himself as having suffered the suffering of the caged patients under his care.

But that is not how Rainaut remembers Cap Manuel; it is not how his story goes. Rainaut’s tale is one of liberation and enlightenment—one that, in scenes reminiscent of Philippe Pinel’s liberation of l’Hôpital Bicêtre, moves from the dark horrors of confinement to the brightly lit spaces of modern psychiatric medicine; one that describes the dawning of a new era of psychiatry in late colonial Senegal. Rainaut writes that even he could not wait to escape the confinement of Cap Manuel and make the transition to Fann. And the patients! As Fann was being built, Rainaut recounts, patients would sometimes accompany staff from Cap Manuel to the construction site. Amazed at what they saw, they would return to Cap Manuel and tell the others about a “sumptuous palace” that was being built for them; Rainaut (1981: 433) jokes that “one could almost construct a new classificatory scheme based on how easily patients were able to project themselves into this wondrous future from the space of a sordid and real present.” In his recollection:

we were ecstatic about the fact that patients would have their own rooms; that these rooms would have windows and doors that would allow daylight in and be lighted by electric bulbs at night; that they would sleep in beds made with fresh linens; that they would take their meals at the table when their health allowed them to do so and if they so desired; and that they would also have forks, spoons, and knives. (432)

The “liberation” and progressive medicalization of madness, which Foucault (1965) has described as having taken place in France and England between the late eighteenth and early twentieth centuries, took place in Senegal on October 17, 1956, when the first convoy of patients was installed at the newly established Fann Psychiatric Clinic in Dakar. And while Megan Vaughan (1991: ix) reminds us that there had never been an “equivalent of what Foucault called the ‘Great Confinement’ ” in colonial Africa—that is, the number of “lunatics” confined within institutions in the colonies had never reached the same dramatic proportions that it had in Paris from the mid-1600s onward—Fann nevertheless represented a departure from the carceral conditions of Cap Manuel and the other psychiatric facilities and practices that had come before it. At Fann, persons suffering from mental disorders would be treated as patients rather than prisoners; they would be referred to as les malades mentaux (the mentally ill) rather than les aliénés (lunatics / the insane; literally “the alienated”). And from the point of view of the late French colonial administration, addressing and treating madness as mental illness within this brand-new, ultramodern psychiatric clinic would serve the dual purpose of underscoring the civility and best intentions of the French colonial mission and itself serve as a civilizing force—one rooted not in the repressive power of the colonial state as was Cap Manuel, but rather in its productive function, through the creation of new habits, subjectivities, and orientations in the world (Bourdieu 1977, 1984; Foucault 1965, 1973). A rehabilitated patient at Fann, as Rainaut’s recollection implied, would be restored to his or her self, life, family, and community. She also would be socialized to French manners and customs until these became second nature. Rather than eating around a communal bowl set upon a woven floor mat (as was, and still is, customary in most households in Dakar and throughout Senegal), patients would eat from a personal plate à table and learn the intricacies of silverware use.

But I am getting ahead of myself. The stories told in this chapter are not about the Fann clinic per se, but about the colonial psychiatric facilities, practices, and unheeded recommendations that came before it in Senegal. As an institution built during the late colonial era, a period in which French rule resembled something closer to welfare colonialism and “care” than brutal subjugation or coercive force, the legitimacy of the Fann Psychiatric Clinic was predicated on its rupture from this violent past. This chapter thus draws upon extensive historical and archival research to trace the vagaries of French colonial psychiatry in Senegal from the construction of l’Hôpital Civil de St-Louis in 1853 to the establishment of Fann in 1956, paying special attention to one of the more terrifying colonial “solutions” to the problem: the forced transportation of les aliénés from Senegal to the Metropole. Between 1897 and the beginning of the Great War, 144 Senegalese men and women were shipped to France and institutionalized at l’Asile de St-Pierre in Marseille. The vast majority of these patients would die in the French asylum; few would ever be repatriated. The violence of this and other early colonial psychiatric interventions stood as an “impossible inheritance” to the new Fann Psychiatric Clinic, which was imagined as a distinct departure from that which had come before it.

It would be a mistake to think that the early French colonial government’s approach to managing madness in Senegal was monolithic or consistent, or that it was the outcome of a coherent scheme or plan. Rather, archival records reveal a remarkable amount of hesitation, frustration, and contestation among colonial officials at various levels regarding what should be done with the colony’s “lunatics” (les aliénés), not to mention a wide array of proposed solutions. We are reminded here that “[c]ontrary to received conceptions of colonial encounters sui generis—and of medical encounters in particular—a mature system of knowledge was not simply exported to the edges of the empire, there . . . to be bestowed or imposed upon indigenous peoples” (Comaroff and Comaroff 1993: 328). Psychiatry stands as a particularly apt example of this, for during the 1800s and even into the early twentieth century, there existed no coherent body of psychiatric knowledge or expertise to be exported to the colonies in the first place—the discipline itself was born during the very same period that European powers were expanding and consolidating their empires across the African continent. Indeed, the evolution of psychiatric science and the assertion of empire were more intertwined than one might imagine (Mahone and Vaughan 2007). For example, as Richard Keller (2007) has brilliantly argued in his examination of French psychiatry in Algeria, France’s overseas territories allowed for a degree of experimentalism that was not possible in the Metropole, thus playing an important role in the advancement of psychiatry itself. What is more, theories of racial inferiority that hinged upon such concepts as the “Arab mind” and the “African mind” were elucidated within the space of the colonial psychiatric encounter and in turn served to reflect, affirm, and justify the French colonial mission. And yet, despite the fact that colonial medicine has often been described as a “tool of empire” (Headrick 1994), colonial regimes “overwhelmingly failed to establish hegemony” (Heaton 2013: 9) when it came to the management of madness in the vast majority of colonial Africa. Facilities and practices that could be called even remotely “psychiatric” touched only a tiny minority of the local populations; resources and manpower were lacking, as was the political will of most colonial governments. For most of the colonial period in Senegal, madness was perceived as a pressing concern to colonial authorities only when it constituted a threat to public order; in this vein Sarr, Seck, and Ba (1997: 214) remind us that most of the colony’s aliénés “remained in the hands of traditional therapists,” which should lead us to question the extent to which it is proper to say that madness was colonized in the first place.

Nevertheless, from the 1890s onwards, colonial doctors began pushing hard on both moral and medical grounds for the establishment of an asylum in Senegal that would usher in a new approach to treating madness in France’s West African colonies.¹ In considering key debates and discussions surrounding les aliénés in colonial Senegal between 1896 and 1956, then, what becomes clear is not simply that ideas about the nature of colonial madness were evolving during the period, or that the French colonial administration’s position vis-à-vis the management of madness finally or inevitably “caught up” to that of the Metropole. More than merely indexing a Foucauldian transition from incarceration to care in the practice of colonial psychiatry, this chapter illustrates the extent to which these debates and exchanges were a key site in which the moral legitimacy of French colonialism was questioned and even challenged from the inside—especially by many of the military doctors themselves. These debates were also key sites for the elaboration of changing ideas about the “African mind,” and about the nature of culture and madness itself.

FRENCH COLONIAL ORDER AND THE THREAT OF MADNESS

France’s first permanent settlements in sub-Saharan Africa were established in the city of St. Louis (Ndar) and the island of Gorée in 1659 and 1677, respectively. More than anywhere else on the continent, France’s early and sustained presence in these coastal enclaves transformed them into something of a testing ground for overseas administration and French colonial policy (Crowder [1968] 1976; Johnson 1971), not to mention a site in which (French) civilization came to be constructed against its “uncivilized” others (Conklin 1997). French policies in this region were marked by experimentalism, and they produced unique forms of exceptionalism throughout the colonial period: French Civil Code was applied in St. Louis and Gorée as early as 1830, and in 1872, the two enclaves were granted the status of French communes (as “communes de plein exercice”) with representation in the French National Assembly (Clark and Phillips 1994; Collignon 1995; Diouf 1998; Johnson 1971). St. Louis and Gorée were later joined by Rufisque (in 1880) and Dakar (in 1887) to form what would come to be known as the Four Communes (Quatres Communes) of Senegal.²

The Four Communes were modeled after French municipalities, each with its own elected mayor and council. African and métis (persons of mixed European and African ancestry) inhabitants of the Four Communes were called originaires, and those who had “assimilated” to French culture were referred to as les assimilés or les évolués. In theory, originaires were permitted to apply for French citizenship, as were les assimilés or les évolués who could prove that they had been living within the Communes for at least five years. However, the administrative barriers to French citizenship were formidable. Unlike the residents of these four coastal cities who could in theory access the status of citizen (citoyen), those living in French-controlled territories outside of the Four Communes were strictly considered colonial subjects. There, the French colonial administration governed indirectly, and residents were subjected to the laws of l’indigénat—a body of colonial laws that enforced such things as taxation, labor drafts, and military conscription.³

During the early colonial era, the French experimented with a policy of assimilation in the Four Communes that aimed to socialize an elite stratum of indigenous inhabitants as French men and women (Crowder [1968] 1976). But local populations were, in fact, quite selective in what they variously incorporated and rejected. They often adopted French political sensibilities while asserting and maintaining values that were distinctly “non-French” and often distinctly Islamic (Lambert 1993: 243; see also Diouf 1998). Identifying with Islam may have even provided local populations with a tool for resisting the cultural force of France’s mission civilisatrice (Johnson 1971).

French assimilation policy, which held that “Africans could and should be educated to assimilate to French culture” (Clark and Phillips 1994: 65), hinged first upon a belief in the superiority of French civilization, and second upon the notion that it was France’s duty and responsibility—even a moral imperative—to bring its civilization to the rest of the world. The legitimacy of French colonial rule, both within the Four Communes and elsewhere, leaned heavily upon this notion of mission civilisatrice. But the notion was more than just a ruse to lend moral justification to the colonial project; by the period of the Third Republic, the civilizing mission was hailed as both “a duty and a right” of the French “to remake ‘primitive’ cultures along lines inspired by the cultural, political, and economic development of France” (Conklin 1997: 2).

By the early part of the twentieth century, although still operating under the banner of its mission civilisatrice, the French colonial administration began to restrict the rights of citizens in the Four Communes and replace the ideal of assimilation with a more “pragmatic” policy of association (Betts 1961). Contrary to the theory of assimilation, which had held that any given individual could be taught to embrace and inhabit French Republican values and dispositions, the theory of association was based on an assumption that peoples throughout the world occupied different rungs on the ladder of civilization, and that moving up this ladder was a long and arduous process that could take many generations. From this perspective, looser colonial “associations” were seen to be both more practical and more humane in that they encouraged colonized populations to move along the path of civilization in their own time. Growing approval for the new policy of association—and a growing distance from the policy of assimilation—was increasingly evident at the annual meetings of th...

Table of contents

• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• Acknowledgments
• Introduction: Entanglements
• Rupture: Chasing a Ghost
• 1 • Archiving Madness: From Colonial Psychiatry to the Establishment of Fann
• Interlude: Many Battles
• 2 • Origin Stories: Collomb’s Fann and Senghor’s Senegal
• Rupture: A Letter Unanswered
• 3 • Nostalgic for Modernity (Or, Looking Back on a Golden Age)
• Interlude: A Terrible Cry from the Past
• 4 • The Ink That Marked History
• Interlude: Each in His Corner
• 5 • Strategic Ambivalence
• Rupture: A Thing I Could Not See (The Joola)
• 6 • Distinctions of the Present
• Conclusion
• Notes
• Bibliography
• Index