University of California Press, 2019. 288 pages.
Katie Kilroy-Marac begins An Impossible Inheritance with a curious epigraph: “The individual can be said to be ‘tangled up in stories’ which happen to him before any story is recounted.” This statement from Paul Ricoeur’s (2002) “Life in Quest of Narrative” echoes Jean-Jacques Rousseau’s (1762) famous quip at the beginning of The Social Contract that “L’homme est né libre, et partout il est dans les fers” (man is/was born free and everywhere he is in chains). Before reading anything about the subject matter of Kilroy-Marac’s book, we are faced with our first “haunting.”
Combining a range of ethnographic and historical methods, Kilroy-Marac slices through the Gordian knot that is “post-colonial transformation” in Senegal and she does this from the vantage point of the Fann Psychiatric Clinic (Service de Psychiatrie – Clinique Moussa Diop). The Fann, founded in 1956, rose to global fame under the directorship of Dr. Henri Collomb, an ex-military doctor working in the French colonial service, who took the reins in 1960. Under Collomb, the clinic was the epicenter of cutting edge transcultural psychiatric research in post-independence Africa. Using the institution as a lens to examine the post-colonial Senegalese state, Kilroy-Marac writes a history of the Fann from Senegalese independence under Leopold Senghor through the early years of Macky Sall’s Presidency since 2013.
The book is also an ethnography of “memory work,” or “the taking up and reworking of the past, as both an imaginative endeavor and a moral practice.” Concerned with the shifting role of “culture” in politics and psychiatry, Kilroy-Marac explores how the history of the Fann is discussed by current and former staff, on what authority they make claims about this history, and how this history is mobilized to effect particular social and political outcomes. She invokes “haunting” as an analytical device to signal tensions around temporality, chronology, and the disciplinary bounds that lie at the heart of this history. These hauntings unfold across six chapters, three interludes, and three ruptures that ultimately reveal “the unsettledness and uncontainability of Fann’s past.”
Chapter one, the pre-history of the Fann, explores the development of French colonial psychiatry in French West Africa (Afrique Occidentale Francaise, hereafter AOF). The chapter moves from the construction of l’Hopital Civil de St-Louis in 1853 to the founding of the Fann Psychiatric Clinic in 1956. The “impossible inheritance” for post-colonial transcultural psychiatry in Senegal is the brutality of French colonial psychiatry, revealed, for example, through the policy of forcibly transporting “lunatics” from Senegal to Marseilles for treatment between 1897 until the end of World War I.
Chapter two takes up the history of the Fann Psychiatric Clinic in early independence Africa. Kilroy-Marac situates Henri Collomb’s multidisciplinary vision of transcultural psychiatry – one pitted against the brutality of colonial psychiatry by incorporating insights from anthropologists, psychiatrist, psychologists, psychoanalysts, and African traditional healers – within the prism of President Leopold Senghor’s invocation of Negritude as a pathway to a “Senegalese modernity.” For President Senghor, Henri Collomb was to the Fann School of Psychiatry as Pablo Picasso was to the Dakar School of Art: a man who could “move across cultural landscapes and blur racial boundaries” with a project “that articulated and accentuated elements of ‘traditional’ Africa in the most modern of ways.”
Chapter three examines the memories of African nurses, translators and social workers who worked at the Fann Psychiatric Clinic under Henri Collomb. The chapter explores nostalgia for the 1960s and 1970s among retired staff as practices of imagination that bring the past into present view and as moral indictments on the state of psychiatric care at the Fann today. That the current Fann doctors eschew collaboration with local healers is viewed by retired staff as a rejection of the history and traditions of the hospital – a disavowal of the Fann’s distinctly “Senegalese modernity.”
Chapter four flips the script by considering the ways that contemporary workers at the Fann, both psychiatrists and other support staff, understand the era of Henri Collomb. The chapter is told through discussions of Dr. Moussa Diop, Henri Collomb’s Senegalese designated successor, after whom the clinic is actually named. The ghost haunting Collomb’s legacy, Diop died before he could take on the mantle as director of the Fann. His untimely death meant that Collomb remained the clinic’s director for a decade longer than anticipated both by himself and his eventual successors. By the time Collomb retired, feelings of resentment were high among many Senegalese psychiatrists who sought to get out from under his thumb. They turned away from Collomb’s brand of cross-cultural psychiatry, embracing instead the universalist claims of biomedical pharmaceutical interventions. Kilroy-Marac uncovers how Diop’s death – at times considered ritually significant – is mobilized by many currently working at the hospital as evidence of the impassable chasm that limits possible engagement, as Collomb championed, between practitioners of Western biomedical psychiatry and African local healing systems.
Despite their rejection of Collomb’s collaboration schemes, his Senegalese successors also engaged in a form of “strategic ambivalence” regarding Collomb’s project.  This is reflected in the simultaneous acts of maintaining yet making irrelevant certain features of care instituted by Collomb, like penc – the regular gatherings of staff and patients alike to discuss the affairs of the hospital – or the intake questions that asked patients about their family deities (raab and tuur). Chapter five discusses another instance of this “strategic ambivalence,” reflected by the organization of the First Pan-African Conference on Mental Health hosted by the Fann Psychiatric Clinic in 2002. Here, Kilroy-Marac describes the active repression of memories necessary for achieving the success of the event – the least of which being that this conference in 2002 was far from the first of its kind in Africa.
Chapter six, which takes place in 2013, 11 years after the conference, examines the transformation of psychiatric care in the intervening years against the backdrop of globalization, neoliberalism, and the economic boom of the first decade of the 21st century. The chapter explores new inventions like the opening of the new V.I.P. ward, alongside contemporary innovations to systems of care put in place under Henri Collomb such as penc, art therapy, and the accompangnant policy (i.e. a supporter who stays with the patient in the clinic – historically a female family member but increasingly a paid employee). In chapter six, we see both a common story of neoliberal capital fueling the unequal distribution of resources and its opposite – “moments of sociality and care in the present-day Fann clinic [that] may hold within themselves the possibility for new lines of flight – other futures – that may themselves bear traces of the earlier forms of sociality and care for which Fann has come to be remembered.”
These six chapters – together the first English-language monograph on the history of Fann Psychiatric Clinic and on psychiatry in French West Africa – are a major contribution to the historical study of psychiatry in Africa. The temporal range alone, 1853 to 2013, afforded by the entanglement of ethnographic and historical methodologies is impressive and uncommon in the field – with most histories of psychiatry in Africa treating the period between the scramble for Africa and the independence era (1880s to 1960s). The true innovation of this book, however, lies in the six “interludes” and “ruptures” that interrupt chronology and distort time – haunting the present moment with ghosts of the past, and injecting into past moments the spirits of unseen futures. These interruptions signal the monograph’s ‘horizons of expectation’ – the spaces “into which all possibilities for the future are inserted – and brought to bear upon the present.” Kilroy-Marac asks us to imagine alternative accounts of the Fann’s history as seen from the vantage point of these horizons.
Apart from Henri Collomb and Moussa Diop, three other ghosts animate these interruptions. One is the psychiatrist and anti-colonial rebel Frantz Fanon. The discussion of Fanon, a critic of Senghor’s brand of Negritude, explores a path to Senegalese modernity not taken in the form of a letter, of admittedly questionable provenance, that Fanon allegedly wrote to Senghor to request the position at Fann ultimately given to Henri Collomb. The author asks the reader to imagine the clinic without Collomb – a Fann with Fanon as its director – and how that might have reshaped the history and contemporary state of psychiatric care in Senegal. Another ghost-like presence are the passengers of the Joola – a migrant ship that capsized in 2002 while Kilroy-Marac was doing fieldwork. The author reveals her shame at not having gone to the port to join the aid mission when the news broke of the capsizing. That the Joola is completely written out of the main chapters of her text is another shame the author acknowledges. It is not clear, however, that the author would have been of any help in that situation.
The third ghost of the interruptions, perhaps the most important figure haunting the monograph is Magatte Ndiaye (referred to as “Demba”) – a painter, sculptor, poet, and one of les anciens – the long-term on and off patients at the Fann. One interlude provides the story of a WWII-era battle on Goree Island that shaped Demba’s upbringing. Another one features his poem, “A Terrible Cry from the Past,” published in the Fann’s patient-run magazine. In a third interlude, Demba describes how he was intimately associated with Henri Collomb and – like the ex-nurses, social workers and translators of chapter three – how he’s found lacking the transformations in care at the Fann since the 1980s. Demba, who also appears in the introduction and a few chapters, emerges as the tragic hero of this text – brilliant, daring, creative, manic, lost, full of hubris, forgotten. In the conclusion, we discover that he passed away in the decade separating chapters five and six. We also find out that Kilroy-Marac did not know of his death until she returned to the Fann. The author’s retelling of this discovery invites the reader to judgement: how was she uninformed of Demba death? To many historians and ethnographers working in Africa, whose work is impossible without the maintenance of relationships such as these, this lapse feels more ethically fraught than avoiding the port in 2002. But one should not be swift to judgement. Kilroy-Marac writes, Demba’s “absence will undoubtedly haunt me, as it does Fann, for many years to come.”
An Impossible Inheritance proposes a rather provocative methodological thesis in African studies: ethnography as history. The civilizational arguments underpinning the claims of early 20th century anthropologists that ethnographic knowledge revealed the truth about a distant African past have been thoroughly debunked. Kilroy-Marac’s explicit attention to “memory work,” however, as both imaginative production and moral practice marks a departure from earlier studies that have tended to mine the memories of African actors (in this case former and current hospital staff) for empirical data about “traditions” (for example, to corroborate rumors that Collomb allowed African healing ceremonies to take place at the Fann). Instead, Kilroy-Marac reveals how these speakers’ words are also political utterances that entail theories of the proper ordering of psychiatric care.
This book is a truly original contribution to the history of psychiatry in Africa. My only qualm is that, like most histories of psychiatry in Africa, Kilroy-Marac takes European colonial psychiatry as a baseline or starting point. Just as Kilroy-Marac has uncovered the various Euro-African inheritances upon which post-colonial psychiatry was built, one wonders about the inheritances, particularly African ones, that shaped French colonial psychiatry in Senegal. What were the pre-colonial repertoires of psychiatric confinement in care among African actors in Senegal in the 19th century? How did the Africans captured and confined by Europeans under colonialism understand this process? These questions, difficult to answer in West Africa given the historical sources available to scholars, are one impossible inheritance of the history of colonial psychiatry in Africa.
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Osei Quarshie is a PhD Candidate in Anthropology & History at the
University of Michigan and a Race, Law & History Fellow at the Michigan Law
School. From July 2020, he will begin as Assistant Professor in History of
Science and Medicine at Yale University.