The essence of psychiatric action would be community life
in a traditional environment that allows
psychotherapy without psychotherapists [1].
(Collomb, 1972, p.109)
Our exploratory work on the topic of mental health and its connection to Senegalese culture will continue in the winter of 2025.
While waiting for the article on return migration resulting from our previous research to be published, we have decided to pursue a new thematic line, attempting to revisit a topic that has been explored throughout previous trips and that has piqued our interest: the figure of the accompagnant familial [2] within Senegalese psychiatric care.
We also believe we would like to broaden our scope of work by including in our research a psychiatric setting with different characteristics than those encountered thus far, attempting to involve a more peripheral area compared to the urban area of Dakar, to enrich and diversify our perspective.
The Moussa Diop clinic, where much of our fieldwork took place, is a center of excellence in psychiatric care in French-speaking Africa. It was established within a university hospital complex, well-known throughout much of West Africa, where residents from across the French-speaking world rotate between the various divisions.
The international atmosphere that occasionally pervades the African reality in which we are immersed, creating a subtle yet powerful contrast between the global dynamics that mark the hospital’s biomedical transformation (Kilroy-Marac, 2014) and the local context, characterized instead by traditional concepts of mental health and care.
The Fann neighborhood, which serves as the backdrop to the clinic, is also in the city center and is crossed by the Corniche, a coastal road constantly crisscrossed by car and motorbike traffic that runs alongside the university, making the hospital easily accessible. Fann Hospital is a sought-after location for the quality of its service and the expertise of its staff, but it is not representative of the more rural areas and those on the outskirts of the large urban center.
We therefore decided to attempt to shift part of our work to southern Senegal, to the Casamance region, a place rich in aquatic resources and mangroves, where animist cults and the veneration of nature spirits and lineage are important elements, as are traditional beliefs intertwined with Islamic and Christian practices.
The best-known psychiatric center in this area is the Émile Badiane Clinic, located in Ziguinchor, the southern capital and economic and cultural center of the region, called Casamance.
This city, with a significantly smaller population than the capital Dakar and practically no traffic, has a decidedly less frenetic pace.
The Djola population, native to this territory, integrates with the migrant population from nearby Guinea Bissau, Gambia, and Guinea, since Casamance, due to its topographical morphology, has always welcomed flows of people from different regions and countries, becoming a crossroads of different cultures.
We contacted Dr. Adama Koundoul, psychiatrist and director of the clinic, to propose an initial meeting in January 2025. He kindly welcomed us and agreed to an in-person interview. Including his clinic in our research not only allows us to engage with a border region that connects diverse geographical and political areas, but also provides us with firsthand experience on the topic at hand: the thesis Dr. Koundoul wrote during his psychiatry residency in Fann specifically addresses the role of the accompagnant within services. Therefore, his direct involvement in the field is beneficial to us.
Before leaving, we are preparing, based on data collected during previous research and in light of articles already published on the topic, the outline of the interviews we plan to conduct with those within the two clinics—Moussa Diop in Dakar and Émile Badiane in Ziguinchor—who come into contact with mental suffering and with this figure, the accompagnant, so specific to the Senegalese psychiatric system and so distant from Western treatments for mental illness.
We are intrigued by this “different double” of the hospitalized patient, this Janus-faced figure who embodies not only the “patient”—the one who, by definition, is afflicted by an illness and displays symptoms of a lack of balance—but also the other, the family member designated to accompany them, the person who for weeks and, in some cases, months, puts their life on hold outside the clinic to act as a liminal figure between two worlds, that of the healthy and that of the insane, at the service of the hospital, of the family left behind, and of the hospitalized family member.
By retracing the origins of this patient-accompanying pairing, we aim to build a profile of what this patient/accompanying combination is today. We attempt to approach the phenomenon from the perspective of the interdependent and correlated nature of this intrinsically connected duality, emphasizing the role of this union within the care and healing process.
Since it is impossible to give an appropriate translation to the word accompagnant with a sufficiently representative and comprehensive Italian equivalent, we will continue in this article to refer to this figure using the French version of the term[3] which aims to describe “the person who is authorised by the hospital and chosen by the family to remain close to the patient for the entire duration of the hospitalisation, to bring him physical and emotional support”[4]> (Gbikpi, 1978b).
The process that leads to the recognition of this role in African hospitals is complex and involves different levels of meaning. In some respects, formalizing the role of the accompagnant represents a way to recognize and legitimize a phenomenon historically present outside African hospitals, where people gathered, often camping nearby for weeks, to wait and support hospitalized patients. As Gbikpi notes, “in Africa, group pressure, which translates into crowds of visitors crowding in front of hospitals, forces healthcare workers to maintain a certain tolerance” [5] (Gbikpi, 1978a).
It is also true, however, that the choice to hospitalize not only the patient but also the family member in a psychiatric setting raises many questions, especially where the accompaniment of a “madman” seemed inconceivable. It was already almost an “aberration” not to lock up the mad, but it was “truly” an aberration to let the “non-madman” live among “aggressive and dangerous patients”[6] (Gbikpi, 1978a).
The reflections of the Ecole de Dakar[7] (Collignon, 1978; Zempleni, 1980), which would lead to a revolution in hospital care and increasingly legitimize this practice by institutionalizing it in 1972, were built on the experimental project carried out by the psychiatrist Thomas A. Lambo in Abeokuta, Nigeria, for people with a condition attributable to Western psychiatric nosography. In 1954, within the psychiatric hospital of While the Aro, established by Lambo and now the most important and prestigious in Nigeria, was under construction, to meet the huge demand for care, a care system was created based on collaboration with the Yoruba population of nearby villages. Construction of the new hospital complex was progressing slowly, and Lambo decided to involve the residents in the project, adopting what he calls “methodological syncretism”—a fusion of Western concepts and traditional knowledge of care—integrating family members and members of the village community into the patients’ psychiatric care pathways. Recalling that period, Lambo writes:
I placed patients in the homes of people who were most tolerant of these illiterate or semi-literate patients. Even today, Africans are extremely tolerant of what Westerners call “deviant” behavior. […] We paid five shillings a night for each patient and another five for each relative. In addition, the villages were provided with electricity and running water to improve hygiene. The inhabitants were farmers, fishermen, and small traders. At first, they were afraid that I would bring schizophrenics and depressives into their homes who would endanger their families. It took a year and a half of negotiations to get the experiment started, but in the end we managed to gain everyone’s unconditional support, to the point that new patients could be welcomed into the villages at midnight and people would open their doors to them. During the twelve years I was there, not a single incident occurred.[8] (Bass, 1994).
The essential condition for admission to the village and to this type of care is the request that a family member take care of the patient, thus promoting their integration into the community.
This project, which had both social and economic significance—the circulation of money allowed the local electricity and water systems to be strengthened and optimized—entailed close collaboration with traditional healers and contributed, within a few years, to the process of destigmatizing the disease through the participation of sufferers in community life and shared responsibility within the community.
In 1956, approximately 300 patients sought accommodation in the village, while over 200 hospital beds remained vacant. In response to this situation, a new day clinic was built directly in the village in 1957.
This approach transformed society’s preferences regarding the treatment of mental illness and the experience of psychiatric care. In 1955, within a 60-mile radius of Aro, for every patient admitted to Aro, 15 were cared for at home.[9] (Nabel, 2017)
One of the central elements of the system implemented by Lambo is the close connection between the population and mental illness, which manifests itself in the community’s active participation in the treatment process. This connection fosters an integrated approach, in which patients are not isolated but are involved in the daily life of the village, receiving support from both their families and traditional healers.
I admitted one schizophrenic or psychotic patient to the hospital and one to the village, at random. I insisted that those who went to the village were accompanied by their relatives. The others were admitted to the hospital alone, just like in New York or Chicago. I wanted to demonstrate that treatment in the village would be quicker, better, and with fewer relapses. Rehabilitation would be easier because the patients were accompanied by their parents. Even during psychotherapy, the mother or aunt sat with us. This meant that when the patient was discharged, no special follow-up was needed to explain to the parents what had been done [10] (Bass, 1994).
This approach values the social context as an integral part of rehabilitation, recognizing the fundamental role of the collective in the therapeutic process.
H. Collomb, in Senegal, observes the same centrality of relationships and group in the healer villages, widespread throughout Southeast Africa and organized around a Muslim spiritual leader or representative of a traditional authority. These villages constitute true therapeutic communities in which the religious and social dimensions are deeply intertwined with the treatment of mental illness. The marabout is not only a charismatic leader who exerts moral and cultural influence on the group, but also a healer who works within the community to intervene in the treatment of the individual. The active participation of the inhabitants, respect for ancestral beliefs, and ongoing support from the group are key factors in therapeutic success.
From these techniques, we can at least underline the importance of the participation of the family group and the community in the care of the patient. In the “traditional hospitals of the savannah,” no patient is welcomed by the healer unless accompanied, for the duration of their stay, by one or more members of their family. Furthermore, the family actively participates in the life of the therapeutic community through donations, agricultural work, construction… This participation, which is never foreseen in Western models, seems fundamental in Africa; it is desirable to institutionalize it.”[11]
(Collomb, 1972).
Two psychiatric villages (Sylla, 1997) were established in Senegal around the mid-1960s: the village of Kénia near Ziguinchor and the village of Botou near Tambacounda. These villages are managed by health personnel and open to families and patients.
The community is made up of healthcare workers, patients and their caregivers, neighbors, and visitors. Daily life brings all residents together in basic activities: cleaning, meal preparation, cultivation, gardening, various crafts using local resources, hut repairs, and more; meetings, communal meals, tea parties, and traditional festivals. Nurses share the same existence; they live in the village with their families. [12] (Collomb, 1977)
The need to create, within hospital departments, a collective living environment inspired by the community model of therapeutic villages, where there is no real separation between roles and individuals, is growing. The idea that madness can be diluted by dissolving the isolation of the sick individual, integrating them into the community, with a network of relationships that influence and participate in the healing process, is taking shape. As Gbikpi notes:
“The patient had to be “diluted” among the assistants and the companions; the multiplication of ‘normal’ individuals to strengthen the patient’s points of reference and allow him to maintain a normal social life. The ideal proportion was 1/3 patients, 1/3 assistants, 1/3 companions, that is, 2/3 healthy individuals for 1/3 patients”[13]. (Gbikpi, 1978b)
The imperative that runs through these shared experiences is not to separate the patient from his or her social and family group, to allow him or her continuous immersion and constant contact with their world. This is not only to avoid isolation, but also because, according to the understanding of mental suffering that was increasingly emerging from clinical and ethnographic observations in villages, the causes of the disorder are considered external to the individual, traceable only to others, outside the body of the sufferer, in a familiar, cultural, and social space that must be learned to read and understand in order to build a clinical practice capable of recognizing and integrating diverse etiologies.
“A tendency was gaining ground which, in its extreme form, could be formulated as follows: the patient is only a symptom, the illness is elsewhere; as a symptom, it is secondary to the disorder it expresses. The disorder is that of the family group or of the family and social group”[14]. (Collomb & Bartoli, 1968).
If in Western therapies the process of evaluation and analysis is constructed starting from the individual, “in his biology, in the sedimentations of his individual history, in the repercussions of his education” (Nathan, 1965, p. 18), in this theoretical model the place to be questioned is within a world made up of beliefs and customs, bonds and relationships, within which interpretations and meanings are possible even of those behaviors defined as mental illnesses by psychiatry.
The individual exists only in relation to others, his meaning is therefore directly connected to the value of the group considered in its broadest sense as an “us that on the one hand digs ditches or erects barriers of differentiation, and on the other establishes connections or invents reasons for assimilation, both in the vertical direction of the ancestors, and in the horizontal direction of the others” (Remotti, 2000, p. 101).
The very concept of the individual can be considered a cultural construct, a form of imposition if attributed to a segment of humanity that did not participate in its construction—as has happened in the West—and does not share the Western conception of the person as a stable, self-sufficient individual who, in order to become and achieve full freedom and autonomy for the purposes of self-fulfillment as a man or woman, passes through the process of separating oneself from the world.
This paradigm challenges the idea of the individual as an independent and separate subject, suggesting instead a more fluid and collective vision of the person, in which freedom and autonomy are manifested not in a break with the social context, but in the ability to live in harmony with it.
The representation of an Ego interdependent with its environment is one of the theoretical foundations of Gestalt therapy, which integrates the organism with its environment in the performance of every function, arriving at defining the field of interaction and not the individual in himself.
In Gestalt Therapy we therefore speak of the organism-environment field (Perls, Hefferline, Goodman, 1951) and not of person and environment to underline the continuity and inseparable interconnection between the two elements.
This concept highlights how the organism and the environment cannot be considered separate entities, but rather parts of a dynamic and integrated system, in which each influences and is influenced by the other. Individual perception, behavior, and experience thus emerge from the continuous exchange between internal and external, and any change in one of the two poles is immediately reflected in the other.
In this way, Gestalt invites us to transcend the traditional subject-object dichotomy and embrace a holistic vision that recognizes the complexity of relationships and the unity of lived experience, emphasizing the totality of the field as a fundamental reality rather than the individual as such.
“But, as Remotti notes, ‘it is not at all simple to describe alternative conceptions to that of the individual, given that this notion is deeply rooted in our way of thinking.'” (Remotti, 2019, p. 237)
The anthropology of the person has long questioned the concepts of person and individual and their cultural declinations.
He ignores his own body, which is only his support. He knows himself only through the relationship he maintains with others. He exists only to the extent that he exercises his role in the game of his relationships. He places himself only in relation to these latter. If we wanted to represent him in a diagram, it would not be a point that we would have to mark with the ego, but several lines indicating the relationships. Each line would correspond to him and his father, him and his uncle, him and his wife, him and his cousin, him and his clan[15]. (Leenhardt, 1947)
Similar observations are found in the writings of the British anthropologist Marilyn Strathern (1988). Commenting on the results of her research in Melanesia, Strathern questions the Western idea of the individual as an autonomous entity, closed and defined in itself, and explores a new term, that of dividual..
Individual people in South Asia are not considered “individuals,” that is, indivisible and bounded units, as is the case in most Western social and psychological theories and common sense. On the contrary, people seem to be generally considered by South Asians as “dividual,” or divisible. To exist, dividual people absorb heterogeneous material influences. They must also emanate from themselves particles of their own encoded substances (essences, residues, or other active influences) that can then reproduce in others something of the nature of the persons from which they originated. [16]
The individual person is not seen as a closed or autonomous entity, but as an open being interconnected with the world and with others. Its meaning and definition contain the intrinsic capacity to absorb and be influenced by the environment and, at the same time, to intervene and influence what surrounds it.
The dividual is like an open channel of continuous exchange and transformation: it draws influences from the outside and simultaneously transmits parts of itself to others, in a dynamic process of interconnection and mutual conditioning. “The dividual is made up of others and relationships with others” (Capello, 2020, p. 38), which is why it incorporates society and is inseparable from it.
It is within this theoretical framework, developed by multiple-universe societies (Nathan, 1965), in which beings are by definition in relation to their surrounding environment and their belonging to the group is central to their process of shaping and shaping as human, that the figure of the accompagnant is inscribed and takes shape.
In an effort to enhance this diversity and give a voice to those who live with a person with mental health difficulties, shifting attention from the individual to the framework of relationships that connect and support them, and placing the family at the heart of the treatment process, the Moussa Diop Clinic is launching a specialization program for doctors in training, inspired by family-systemic theory. The goal is to equip future psychiatrists with tools that can assist them in clinical discussions with patients and in the discussion process that supports pharmacological therapy.
According to systemic theory, it is important to train one’s gaze to grasp the complexity of the family system, restoring competence and meaning to the various actors that comprise it. From this perspective, the figure depicts the group with the network of relationships in which the hospitalized person is immersed, a group that has healing power, equal to the medical one.
It is not the patient who is at the center of treatment, but the network of relationships that connect the person to their environment.
“Systemic therapy allows a holistic approach to mental pathology, integrating the classical medical method but also family and even social interactional modalities. Families are empowered and actively participate in the therapy”[17]. (Sylla & Thiam, 2008).
During hospitalization, the various discussions between the accompagnant and the healthcare team not only allow for greater integration of the various pieces of the patient’s family history in the anamnesis, but also enable a broader reconstruction of the meanings underlying the onset of symptoms.
The family is the origin of psychiatric symptoms, interpreted as a creative adaptation to a dysfunctional system of which the accompagnant is a direct representative.
Therefore, not only does the caregiver occupy an extremely delicate position as a representative of the family unit alongside the hospitalized person, constrained by different demands and often designated as a scapegoat by various stakeholders, but he or she also serves as a narrative intermediary between the family and the medical team, often assuming the role of translator between worlds characterized by different languages. As Ory notes, “the accompanist is therefore used by the medical team as a therapeutic tool, providing insight into the relationships between the patient and the people around him” [18] (Ory, 2017).
Like a tightrope walker, the accompanist maintains these balances by monitoring the hospitalized person and offering practical support for personal care and hygiene, “the accompanist is the extension of the patient’s hands and feet” [19] (Kiemde, 2024) as well as playing an important role in emotional support and control and restraint.
His work in close contact with the team of doctors and healthcare workers and his immersion within the hospital wards allows him to acquire a certain psychiatric culture that will allow him to be the continuator of the therapist’s action outside the hospital, to the point of being defined as a co-therapist:
[The accompagnant] becomes in some ways the health worker’s co-therapist within the patient’s family. The accompanying person provides the family with advice and assistance. They inform the family about the importance and respect for treatment and visits, as well as about the attitudes and behaviors to adopt towards the patient[20]. (Koundoul, 2015).
But if much of the clinical care revolves around this pivotal figure in the Senegalese psychiatric system, what kind of support is offered to this presence? How does the family member enter into their role as accompanying person and co-therapist and how is they involved in pharmacological and psychoeducational therapy?
Our research is built around these questions. Through interviews and discussions, we explore the present of this key player in the hospitalization process, still crucial and decisive in clinical work today.
While much has been done in the past to support this presence through speaking groups, meetings, and collaborative work, much remains to be done today.
The Structural Adjustment Programs (PAS), which have imposed drastic cuts to public healthcare by reducing hospital beds and healthcare workers, have also weakened the maintenance of some of the tools once used to sustain traditional community networks. Few spaces are now dedicated to the implementation of the Penc or Kéloumag, speaking groups led by patients, caregivers, and doctors, which were once central venues for discussion and debate on issues related to hospitalization and therapeutic practices. Likewise, there is almost no trace of the Bantamba, a working group run at the Ziguinchor clinic composed of caregivers and healthcare workers.
Family accompagnant often work alone, facing daily emotional, logistical, relational, and financial difficulties, without the necessary tools or a stable support network.
Despite these transformations and the increasingly widespread introduction of paid or institutional accompagnant [21], that is, people outside the family who are paid for their caring service, families continue to choose someone from the family first, relying on someone outside the nucleus in extreme cases when no family member is available or when the person to be cared for has an aggressive nature that is difficult to manage.
It’s clear that choosing an institutional caregiver is, in some ways, a financial decision for the family, which is also attractive to the public institution, which thus feels relieved of the responsibility of caring for and supervising the individual patient. However, reducing this important model to a simple mathematical calculation is truly reductive.
The approach described in these pages, which focuses on the dyad rather than the individual, and which focuses on the between of the relationship rather than the intrapsychic aspects of the subject, proposes a vision of human experience as co-constructed in the encounter with the other, where the bond becomes the primary locus of meaning and change. It risks becoming impoverished and disintegrated by conforming to the dominant Western paradigms that leave the person with psychiatric fragility alone, rendering them increasingly invisible.
We believe that there is much to learn from the therapeutic duality that the institution of the accompanist implies, and that the isolation that accompanies people with a psychiatric disorder and their families in our society can be countered through the construction of projects aimed at involving the social fabric and aimed at creating that herd solidarity [22] described by Thomas Adeoye Lambo of African villages, that group solidarity made of relationships and true words that not only accompany the treatment but make it possible.
In conclusion, we recall that this research had two objectives. The first helped us understand how the institution of the accompanist functions today in the Senegalese psychiatric context. The second was to reflect on what we can learn from this intervention model and how we can contextualize it to promote the mental health of people treated by psychiatric institutions in Western societies, where psychiatric disorders are often interpreted as illnesses of the individual and treatment focuses on the individual’s intrapsychic conflicts. Our stay in Senegal allowed us to engage with non-Western conceptions of the person, illness, and treatment, and this enabled us, above all, to recognize and question our own conceptions of mental health.
[1] Our translation of the original text: «L’essentiel de l’action psychiatrique serait la vie communautaire dans un environnement traditionnel permettant une psychothérapie sans psychothérapeutes». (Collomb, 1972, pag. 109).
[2] In this article, the word accompagnant refers to the figure of the accompagnant familial (family member), i.e. a person belonging to the immediate or extended family who offers to accompany a relative during hospitalization. This is distinct from the accompagnant istitutionel (also called mercenaire), who is instead an accompagnant, whether employed by the hospital or not, paid by the family to support the patient during hospitalization. While the role of the former was historically conceptualized in an innovative psychiatry developed in Senegal starting in the 1960s (Collignon, 2018), the latter has gradually been structured within Senegalese psychiatry, taking on different shades of meaning over time (Kilroy-Marac, 2014).
[3] La parola accompagnant viene tradotta letteralmente in italiano con i vocaboli, accompagnante o accompagnatore. Gbikpi nel suo articolo del 1978 boccia questa trasposizione del termine perché non risponde pienamente alla funzione data al ruolo dell’accompagnant. Non è un tecnico con specifiche competenze relazionali ma semplicemente un essere umano che vive con il malato (un être humain vivant avec le malade, pag. 4). La traduzione libera in italiano del termine associa invece questa parola alla figura di badante o operatore sociale, spostando però nuovamente l’accento dall’elemento famigliare e intimo a quello più professionale.
[4] Our translation of the original text: « En médecine générale, c’est la personne autorisée à rester auprès du malade pour lui apporter un soutien physique et affectif». (Gbikpi, 1978b, pag.7).
[5] Our translation of the original text: « D’une manière général en Afrique, la pression du groupe, traduit dans la foule des visiteurs qui se pressent devant les hôpitaux, oblige les soignant à une certaine tolérance ». (Gbikpi, 1978a, pag.12).
[6] Our translation of the original text: « L’accompagnant d’un “fou” semblait inconcevable. C’était déjà presque une “aberration” de ne pas enfermer les fous, mais ç’en était “vraiment une” de faire vivre le “non fou” parmi des “malades agressives et dangereux”». (Gbikpi, 1978a, pag. 13).
[8] Our translation of the original text: «I billeted patients in the homes of people who showed the greatest tolerance for these pre-literate, or illiterate, patients. Even today Africans are tremendously tolerant of what Westerners call “deviant” behavior. We paid five shillings a night for each patient and another five for each relative. In addition, the villages were given electricity and piped water to improve hygiene. The people living there were farmers, fisher- men, and small traders. At first they were afraid I was going to put into their homes schizophrenics and depressives who would endanger their families. It took a year and a half of negotiations to set up the experiment, but finally we got everyone solidly behind the project, so much so that new patients could be taken into the villages at midnight and people would open their door to them. During the twelve years I was there, not a single incident took place». (Bass, 1994, pag.74).
[9] Our translation of the original text: «In 1956, roughly 300 patients sought vacancies in the village, while over 200 beds in the hospital remained empty. In response, a new day clinic was built directly into the village in 1957. This approach transformed societal preferences for treating mental illness and experiences of psychiatric care. In 1955, within the 60-mile radius surrounding Aro, for every patient admitted to Aro, 15 were cared for at home». (Nabel, 2017, p. 6).
[10] Our translation of the original text: «I’d put one schizophrenic or psychotic in the hospital and one in the village, at random. I insisted that those going to the village be accompanied by their relatives. The others went into the hospital alone, just like in New York or Chicago. I wanted to prove that the village cure would be faster, better, with fewer relapses. Rehabilitation would be smoother, because the patients were accompanied by their parents. Even during psychotherapy, the mother or aunt would sit with us. This meant that when the patient was discharged, there was no special follow-up to explain to the parent what was being done». (Bass, 1994,pag. 72).
[11] Our translation of the original text: « De ces techniques, on peut retenir au moins l’importance de la participation du groupe familial et de la collectivité au traitement du malade. Dans les « hôpitaux traditionnels de brousse », aucun malade n’est reçu par le guérisseur s’il n’est accompagné, pendant toute la durée du séjour, par un ou plusieurs membres de sa famille. En outre, la famille participe effectivement à la vie de la collectivité thérapeutique par des dons, des travaux de culture, des constructions… Cette participation qui n’est jamais prévue dans les modèles occidentaux paraît fondamentale en Afrique; il est souhaitable de l’institutionnaliser ». (Collomb, 1972, p. 109).
[12] Our translation of the original text: « La communauté se compose du personnel soignant, des malades et leurs accompagnants, des voisins et des visiteurs La vie quotidienne réunit l’ensemble des habitants dans des activités de base: nettoyage, préparation des aliments, repas; cultures, jardinage, artisanat divers en rapport avec les ressources locales, réparation des cases… ; réunions, repas communautaires, séances de thé, fêtes traditionnelles. Les infirmiers partagent la même existence; ils vivent au village avec leur famille ». (Collomb, 1977, p. 113).
[13] Our translation of the original text: « Le patient a dû être dilué parmi les soignants et les accompagnants; la multiplication des individus “normaux” devant renforcer les éléments de référence du malade et permettre d’entretenir une vie sociale normale. La proportion idéal retenue était de 1/3 de malades, 1/3 d’accompagnants, 1/3 de soignants, soit 2/3 d’individus “sains” pour 1/3 de malades». (Gbikpi, 1978b, p. 13).
[14] Our translation of the original text: « Une tendance s’affirmait qui, dans sa forme extrême, pouvait être ainsi formulée: le malade n’est qu’un symptôme, la maladie est ailleurs; en tant que symptôme, il est secondaire au désordre qu’il exprime. Le désordre est celui du groupe familial ou celui du groupe familial et social ». (Bartoli, Collomb, 1968, p. 176).
[15] Our translation of the original text: «Il ignore son corp, qui n’est que son support. Il ne se connaît que par la relation qu’il entretient avec les autres. Il n’existe que dans la mesure où il exerce son rôle dans le jeu de ses relations. Il ne se situe que par rapport à celles-ci. Si on voulait l’indiquer dans un schéma, ce n’est pas un point qu’il faudrait marquait avec ego, mais des traits divers marquant des relations. Chaque trait correspondant, à lui et son père, lui et son oncle, lui et sa femme, lui et sa cousine croisée, lui et son clan ». (Leenhardt, 1947, pag.248).
[16] Our translation of the original text: « Persons single actors are not thought in South Asia to be ‘individual’, that is, indivisible, bounded units, as they are in much of Western social and psychological theory as well as in common sense. Instead, it appears that persons are generally thought by South Asians to be ‘dividual’ or divisible. To exist, dividual persons absorb heterogeneous material influences. They must also give out from themselves particles of their own coded substances essences, residues, or other active influences that may then reproduce in others something of the nature of the persons in whom they have originated». (Strathern, 1988, p. 348).
[17] Our translation of the original text: « La thérapie systémique permet une approche holistique de la pathologie mentale, intégrant la méthode médicale classique mais aussi les modalités interactionnelles familiales voire sociales. Les familles sont responsabilisées, et prennent une part active à la thérapie ». (Sylla & Thiam, 2008, p. 50).
[18] Our translation of the original text : « L’accompagnant est alors utilisé par l’équipe médicale comme outil thérapeutique en ce qu’il donne un aperçu des relations entre le malade et son entourage ». (Ory, 2017, pag.45).
[19] Our translation of the original text : « L’accompagnant est le prolongement des pieds et des mains du malade ». (Kiemde, 2024, p. 114).
[20] Our translation of the original text: « Il devient en quelque sorte le cothérapeute du soignant au sein de la famille du malade. L’accompagnant apporte à la famille conseils et assistance. Il informe la famille sur l’importance et le respect du traitement et des consultations sur les attitudes et les comportements à adopter face au malade ». (Koundoul, 2015, p. 46).
[21] For a more in-depth analysis on this topic, see the article by Diagne & Lowell (2019).
[22]«Sometimes entire villages would rent a truck and arrive at the gates of Aro Hospital at four in the morning. One night I counted sixty-four people on three huge trucks. They had probably been traveling for days, having traveled up to a thousand kilometers. The patient was tied up with ropes, suffering from schizophrenia or another form of psychosis. But if it was the son of a chief or the chief himself, the entire village would come out in solidarity. I collected testimonies from all these people, from the patient’s mother, his wives, cousins, uncles, and so on. How had his illness manifested itself? How long had he been behaving strangely? It wasn’t just Mrs. Smith who told the psychiatrist about her husband’s strange behavior. It was the entire village recounting months of observations.. (Bass, 1994, pag. 82)
Our translation of the original text: «One night I counted sixty-four people in three huge lorries. They might have been on the road for days, travelling up to seven hundred miles. The patient would be bound in ropes, suffering from schizophrenia or another form of psychosis. But if he were the son of a chief or the chief himself, the whole village would come in solidarity. I took case histories from all these people, the patient’s mother, his wives, cousins, uncles, and so on. How did his sickness first manifest itself? How long has he been acting strange? This wasn’t just Mrs. Smith telling the psychiatrist about the odd behavior of her husband. This was the whole village recounting months of observations». (Bass, 1994, p. 82)
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