The Case of S.C.
In the very first issue of Psychopathologie Africaine in 1965, Dr. Henri Collomb, Dr. Paul Martino, and sociologist-ethnographer AndrĂĄs ZemplĂ©ni published the case of S.C., a man consigned to psychiatric care because he had murdered someone he thought was a witch (Martino et al. 1965). This case captures some of the most enduring complexities of transcultural psychiatry. Martino and Collomb were psychiatric medical doctors trained in Lacanian psychoanalysis. ZemplĂ©ni was trained as a sociologist. Zempleniâs employment at Fann already demonstrates the atypical practice that included substantial interests in social dimensions of mental health and healing. These men observed that S.C.âs case demonstrates the singular position of Western psychiatry in an African milieu, including diagnostic difficulties and the artificiality of nosographical categories (Martino et al. 1965, p. 151). The life-world of S.C. differed so significantly from that of the French hospital personnel that it stymied their psychiatric methods. The signature Fann technique responded with meticulous attention to the specifics of the individualâs life, so that the S.C. case history reads almost like a condensed murder-mystery.
We learn immediately that S.C. had never suffered any previous psychological problems. He was employed on the railway and had earned an iron cross during his military service in France. He was clean living and neither smoked nor drank. His daughter F.C., however, was known as a bad character; she was insolent and had frequent altercations with other people (Martino et al. 1965, p. 151). One day at the local fountain she quarreled with a young neighbor woman. This womanâs father-in-law reproached F.C., âIâll get you and you will never again see your father or your motherâ (Martino et al. 1965, p. 151).
That night F.C. became very agitated, she thrashed about and cried: âtheyâre going to get me, theyâre going to kill me.â Subsequent headaches and nose bleeds were followed the next day by lethargy. Her whole family was extremely upset and the father (S.C.) rushed to the sorcerer to beg for his forgiveness and for his help. The sorcerer came to F.C.âs bedside and in an attempt at a cure applied a secret ointment and Quâranic verses. The next day, however, the girl was worse. She could no longer see and appeared to be almost dead. In a panic the family took her to the hospital. S.C. (the father) returned to the sorcerer and begged him again to aid his daughter. The sorcerer this time said no, he had already done all that he could.
At this point S.C. was overcome with rage and attacked the sorcerer, killing him. He also wounded the sorcererâs wife who tried to intervene (Martino et al. 1965, p. 152). Once the sorcerer was dead, the daughterâs health returned to normal. From his jail cell, S.C. regretted the murder, but was happy to have saved his daughter.
While S.C. was in jail, the wife of the sorcerer took up her dead husbandâs cause and began persecuting S.C. Each night she would leave her body, take on the shape of birds or a lion, and come to attack S.C. She used, according to S.C., magic formulas that could kill without a trace. S.C. professed to know other magical formulas that alone could deter this black magic, and he shared these formulas willingly with his doctors (Martino et al. 1965, p. 152).
The doctorsâ physical exam of S.C. revealed no pathologies. Mentally and emotionally, he was in good form. Only his dreams plagued him, and he believed in all earnestness that they were real. Martino, Zempleni, and Collomb placed S.C.âs convictions within the context of broader African and specifically Wolof belief in witchcraft, reflecting that,
among the Wolof attacks by witches remain frequent and feared. The sorcerer döem is a man whose human appearance is identical to other men. He has the power to take on animal forms or to become immaterial in order to attack. It is generally agreed that only the soul of the sorcerer transforms itself. His fleshy envelop does not participate in these attacks. Attacks are generally carried out at night. The victim is devoured through two essential organs, the liver and the heart, which are reservoirs of fit (vital energy).
(Martino et al. 1965, p. 153)
This devouring brings on certain, usually sudden, death. In some cases, however, these vital organs are set aside to be shared with a sorcererâs confraternity: this brings on a slower death.
What constitutes mental illness in this scenario? According to S.C.âs community, his mental illness was demonstrated by the fact that he acted on his own impulse and without the support of his community. Martino, Zempleni, and Collomb acknowledged this community standard of mental illness, emphasizing that S.C. did not have the right to kill the sorcerer because he and his family had not obtained a community consensus about the witchcraft. The usual course of events should have involved a consultation with a healer who might have removed the curse or identified the witch. Instead, in this case, S.C. brought the witch to his daughterâs bedside, begging him to undo his own magic. When that failed, he killed the sorcerer. It is because he violated the customary practices concerning witchcraft â not because he believed his daughter had been bewitched, nor even because he murdered the man he suspected of witchcraft, but because he did so without having followed the communal procedures â that his peers considered S.C. mentally ill.
From a Western psychiatric point of view, S.C. was suffering from delirium. The murder committed by S.C., according to Dr. Collomb, Zempleni, and Martino, was a first manifestation of an âacute psychosis or systematic complex delusion with themes of persecutionâ (Martino et al. 1965, p. 155). The original French used the term âbouffĂ©e dĂ©lirante,â which is a specialized French diagnosis discussed in Chapter 9. For the present discussion, âacute psychosisâ suffices. The attacks suffered while in prison, including visual and verbal hallucinations and sensory disorientation, in the doctorsâ estimation, confirmed this diagnosis (Martino et al. 1965, p. 156). Zempleni, Martino, and Collomb, however, were troubled that their diagnosis confirmed the social view of S.C. â that he was suffering from mental illness â but that they arrived at this conclusion very differently than did S.C.âs community. The medical team were confounded by the fact that two very different logics upheld the same conclusions about S.C.âs behavior. For the doctors, S.C.âs hallucinations were the chief indicator of mental illness. These doctors were aware, however, that among the Wolof, it was not at all unusual to have perceptions without an objective cause (Martino et al. 1965, p. 156). From the Wolof point of view, S.C.âs transgression of the ancestral law is the chief sign of his madness, but such transgression from a psychiatric point of view was of little or no consequence (Martino et al. 1965, p. 156).
The judges from the criminal court, meanwhile, focused on yet another topic. They wanted to know if S.C. was a danger to society. Would S.C. murder again? Martino, Zempleni, and Collomb considered this medico-legal concern carefully. They weighed their psychiatric knowledge â which gave S.C. a good prognosis for recovery â against the prospect of him falling victim to witchcraft again. This was very possible, but they happily reported that S.C. had protected himself from further attacks by securing the services of a bilĂ©dio (a Toucouleur witch chaser and in this case a very renowned one who lived near the Senegal river). The bilĂ©dio would protect S.C. from further attacks, so Zempleni, Martino, and Collomb decided S.C. posed a minimal threat to the community and most likely would not murder again.
S.C.âs case prompted the team of doctors to reflect that Western psychiatric diagnostic criteria could be employed in such situations only tentatively and with reservations. The people of Dakar and wider Senegal accepted as normal experiences what to Western medical eyes appeared as delirium and hallucinations. On the other hand, such experiences were common and a part of the normal fabric of Senegalese life. In this social milieu, French (or, biomedically trained) doctors lost their chief diagnostic criteria. In Western biomedical psychiatry, delirium and hallucinations composed the hallmarks of mental illness (Martino et al. 1965, p. 157). At the Fann Hospital, and working with the diverse West African population of Dakar, the doctors had to learn to define mental illness differently. They adopted a standard that abstracted from the local perspective: the individual dangerously out of step with communal expectations became the chief indication of mental illness. This psychiatric standard for mental illness in Senegal was an abstraction from the Wolof aversion to transgressing ancestral rules. This standard also reflected a perspective on psychiatry informed by Georges Canguilhem and Michel Foucault, for whom dangerous deviation from the norm is constitutive of mental illness (Canguilhem 1943; Foucault 1961). The physiological perspective, discussed in-depth in the next chapter, integrates the individual who is somehow out of sync, within an understanding of physiological regulation and dysregulation. The rhythm of the heart â which in a sociable state is patterned, and in an excited state beats steadily with unrelenting speed â enables the prosody of voice. Social engagement via micro-facial gestures, the perceptive tilt of the head, or a subtle crease of the eyelids carry an individual in to successful social relationships. Unsuccessful relationships produce physiological dysregulation which in turn impedes other social relationships. The narrativized environment enmeshes with physiological processes, whether those are regulated or dysregulated, and in either case, whether habitual or acute and transient. Acute dysregulation can give rise to sudden mental distress. Habitual dysregulation can express as long-term and entrenched spiritual and psychological difficulties. The narrativizing of physiological states is a powerful force not just for categorizing experience but also for decision-making and on-going participation in further narratives, whether collective, individual, traditional, innovative, or idiosyncratic.
Driven by Western expertise in psychiatry, psychology, sociology, and philosophy, the 1960s and 1970s transcultural project at Fann Hospital aimed to prioritize Senegalese beliefs and practices. This proved a tantalizing enterprise that drew hospital personnel to local rituals related to spirit possession, witchcraft, and magic, and yet which also relied on at least some Western biomedical, philosophical, and psychological assumptions. In effect, the transcultural psychiatrists aimed to integrate widely disparate narrative practices: including medical doctors, psychologists, traditional healers, and sociologists, all within a unified search for healing.
Marabouts and Healing at Fann Hospital Compared to the Colonial Era
The early years of the Fann Hospital journal, Psychopathologie Africaine, reflect the enthusiasm and creativity of the efforts of these Western-trained psychiatrists, psychologists, and sociologists to integrate Western psychiatry and psychoanalysis into a therapeutic regime that accepted as well a wide variety of Senegalese healing practices. This creativity, however, never completely shook free of the cultural and racial hierarchies of the colonial period.
Martino and Marie-CĂ©cile Ortigues addressed the disparity between the treatment administered at Fann and the pervasive interest among Fann personnel in Senegalese beliefs and practices regarding troubles of the spirit. For their patients from Dakar â patients who most commonly were Wolof, Lebou, or Serer â the doctors were viewed as men of science to which one could trust oneâs body, but the doctors were also always, irredeemably, âforeignersâ (Martino and Ortigues 1965). Therapeutic relationships that could heal the spiritual troubles of these patients escaped the competence of these foreign disciples of science and fell instead to those referred to generally as marabouts. For the patients at Fann Hospital, according to M-C Ortigues and Martino, Western-trained doctors could calm and strengthen the fragile body, but true healing required a parallel treatment of the soul by a local healer. In effect, then, the personnel at Fann worked within a recognized limit to their competence. As much as they were fascinated by the therapeutic rites of healers, they themselves remained largely tied to biomedical treatment of the body and mind.
Nonetheless, witchcraft and spiritual healing figured prominently at Fann, both within the course of treatment of patients and within the medical the personnel. Moussa Diop â the sole Senegalese doctor at Fann in 1965 â and Henri Collomb evoked the complicated array of healers within the region of Dakar with the remark that in Senegal, a country Islamized already for several centuries but also preserving pre-Islamic practices, the term marabout was used broadly and could signify âauthentic marabouts as well as charlatans and other âturbaned healer...
