“Therapy is essentially based on community life in a place where the patient is accepted, listened to, and recognised as a person. Through listening and paying attention to others, every member of the community can become a therapist for every patient. The care team’s main objective is to encourage and animate this community life; the aim is less to treat in the medical sense than to enable patients to express themselves, to be listened to, considered and valued; to allow everyone to discuss their problems with others and share in common activities.”

(Collomb, 1978, p. 114, my translation)¹

In the two previous articles, “Shifting Boundaries: Towards Other Ways of Understanding Otherness” (Prato, 2024) and “The Figure of the Accompagnant” (Prato, 2025), we explored aspects of psychiatric care at the Moussa Diop Psychiatric Centre of the CHNU, located in the Fann district of Dakar, Senegal. Those pages examined how psychological distress takes shape within a web of relationships involving the community, institutions and other frameworks for interpreting suffering. Particular attention was paid to the accompagnant, a central presence in hospital life whose role reveals a different way of experiencing and understanding the process of recovery.

While those first writings described our encounter with the institution in Dakar, where most of our previous missions had taken place, the experience I recount here unfolds further south, in the Casamance region, at the Émile Badiane psychiatric facility in Ziguinchor. It opened in 1974 as the Kénia psychiatric village, on the initiative of Professor Henri Collomb.

Today, the centre records around 7,000 visits a year, including initial consultations, ongoing care and hospital admissions, across its 18 hut-like rooms, which retain the original layout established in 1972.

Compared with the capital, this is a profoundly different geographical and social environment, shaped by the Casamance River, its waterways and mangroves, and situated close to the borders with The Gambia and Guinea-Bissau. Its proximity to these countries means that the centre receives patients not only from various regions of Senegal but also from cross-border areas, making clinical care richer but also more complex.

In this setting, the deep and inseparable connection with nature found in Djola culture and animism continues to influence, at least in part, local ways of making sense of what psychiatric nosography defines as mental illness. The hospital becomes a place of passage where different systems of meaning meet and are negotiated.

Within its walls, the diagnostic and therapeutic frameworks of biomedicine now prevail, while the original approach developed by Henri Collomb is still retained: he conceived treatment as continuous with the patient’s social environment, preserving the continuity between the individual and the family. Outside the hospital, other ways of understanding mental illness remain active, rooted in traditional medical knowledge and in the authority of guérisseurs, or traditional healers.

It is against this backdrop that this account of a new experience takes shape. To understand it, we must return to February 2026.

At that time, I decided to spend three months at Émile Badiane Hospital, which I had already visited twice. In the meantime, the Gestalt Psychotherapy Training School in Turin (SGT) had signed a collaboration agreement with the hospital.

To support the project, I invited Mariano Pizzimenti to join me for a few weeks.

I felt it was important to create an opportunity for direct exchange with Senegalese colleagues, introducing the ideas of Gestalt therapy and opening a dialogue through a gradual process of aligning our languages and theoretical frames of reference. We therefore decided to launch the project with an introductory day devoted to the fundamental principles of Gestalt therapy and how they can be applied.

Two closely connected aims guided me throughout this process. First, I wanted to explore the possibility of developing psychotherapeutic work in a setting where psychologists are absent and the profession has not yet received institutional recognition. Second, I intended to begin the process required for the hospital to become a placement site for trainees from our school, in accordance with the procedures established by Italy’s Ministry of University and Research (MIUR).

Now, as the first trainee from our school prepares to leave for their placement and this process has finally reached fruition, I feel it is important to pick up the thread and continue the account.

In the following pages, I will revisit the weeks spent at the clinic through the ethnographic diary I kept during my stay, in the hope that writing about the experience will help clarify what I lived through.

From the very beginning, one sentence stood out to me. Several staff members repeated it during our first training day, after shaking our hands and introducing themselves: “There is a great need for psychotherapy here.” Put this way, it sounds simple, almost self-evident, in an environment without this professional role and engaged in the gradual integration of neurobiological approaches to mental illness, where psychologists are generally an integral part of the team.

The more I repeat these words to myself, the more I realise that they need to be questioned, almost taken apart to examine the assumptions they carry. What remains unspoken must be made explicit, so that we can maintain a perspective capable of recognising what is already there before interpreting it through familiar, established frameworks. At the same time, it becomes essential to critically examine the idea of the human being underlying our theories, which are often based on an implicit view of the person that is taken to be universal.

Only in this way can we partly avoid projecting our interpretive frameworks onto others and imposing our systems of meaning on their thinking.

How can a psychotherapy training school enter into dialogue with this reality without simply transferring ready-made models? And how can our work find a place between hospital medicine and the other systems of healing that shape the local context?

I feel caught in a bind: on the one hand, I do not want to passively accept a request for a pre-packaged framework; on the other, I am aware that this is precisely the perspective within which I have learned to think and work.

My experience in ethnopsychiatry over the years has always taken place in a plural setting, where dialogue with an ethnoclinical mediator and an anthropologist has been essential to approaching the other. The prospect of finding myself alone with a patient whose culture differs from my own frightens me a little. Perhaps, however, it is precisely this uncertainty that marks the beginning of the journey.

As these thoughts run through my mind during the first weeks of my stay, I begin to imagine, together with the director of Émile Badiane, what contribution I might make to the care provided to patients and their families.

We decide to begin with a period of shadowing psychiatrists and nurses. During this time, I take part in daily consultations, when medical records are opened, admissions initiated and care plans established. I also join the afternoon group activities involving inpatients and their accompagnants, as well as the Wednesday morning ward rounds in the various rooms. The latter prove to be a precious opportunity to get to know the setting and immerse myself in the many dynamics of everyday life, allowing me to observe meaningful exchanges between medical staff and families.

I have just completed the final ward round before returning to Italy. At times, this moment resembles group therapy, and it is perhaps the time of the week when patients and their families receive the most attention, without the haste that usually accompanies healthcare routines.

I am reminded of an interview with T. Lambo², in which he observes that one of the great limitations of psychiatrists, compared with traditional healers, is the little time they can devote to the person and to the relationship. Their questioning is always hurried; urgency seems to be a structural feature of their assessment, aimed almost exclusively at reducing symptoms. During the ward round, however, I have the impression that something different happens. Curiosity can linger on hair that needs cutting, the amulets people wear, and the marks drawn on their bodies.

I enjoy making my way with everyone through all 18 huts to meet the people staying in the hospital. We sit on the beds—two in each hut, one for the patient and one for a family member—while other relatives, sometimes numerous, find places on woven mats inside the room or on the walkway outside. Dr S. is the only person who sits on a wooden chair, a position that lends him a certain authority. Yet the chairs in the huts are small, like the chairs used by children at school. The contrast strikes me every time and has a strange effect.

Gathered close together, hot and sticky with sweat, we talk about how the hospital stay is progressing, and stories of people’s lives and memories often surface.

The accounts, almost always told in Wolof, connect the present with what has been left at home. They describe the community’s balances, alliances and conflicts, as well as the departures of those who have migrated elsewhere, leaving behind absences that continue to reverberate among those who remain.

It is the group, rather than the individual inpatient, that is addressed. Through the voices of others, the individual takes shape and becomes understandable within a network of relationships. Their individuality acquires meaning insofar as it is embedded in a collective that helps define their place and significance in the world.

I sensed a similar atmosphere during the night shift I worked on Monday with Nurse F. As evening falls, the setting comes to resemble a small village even more closely.

In the central part of the facility, the “little square beneath the shelter” (Francesca Ambrosoli, ethnographic diary, 23 March 2026), patients and relatives gather, talk and linger in more intimate conversations.

Nurses move between the huts and the little square to administer treatment, while family members prepare dinner. At such moments, professional care merges with everyday life, and the boundaries between different roles gradually begin to blur.

(8 April 2026, ethnographic diary)

After the first weeks of observation, in agreement with the Guinean psychiatrist with whom I work most closely and with the hospital director, we decide to offer a structured course of six sessions to people attending consultations who might benefit not only from medication but also from the opportunity to talk about what they are going through.

“Il faut libérer la parole” (“We need to set speech free”), one psychiatrist says during a discussion, as though words were imprisoned, waiting to be released. I think the sessions may offer an opportunity to understand the context in which I find myself more fully and to further inform my thinking about possible future projects.

The first meeting is devoted to explaining the psychotherapeutic framework. After that, each person is free to contact me if they wish to continue with the remaining five sessions, thus avoiding the start of therapeutic processes that might not be able to continue.

It is not easy to translate the essence of my work or describe the mechanism that is usually taken for granted. The more I explain how what I do works, the more aware I become of the almost magical quality of this process of unveiling: it places the power of healing in the use of words and rests on a particular way of constructing thought and developing reflective capacity.

The idea that a deeper understanding of oneself and one’s suffering can support the healing process and, over time, contribute to the remission of symptoms presupposes a psychological theory and a model of the human being that may not be applicable to every population.

“Much of psychological theory and psychotherapeutic practice has been underwritten by implicit notions of the person in U.S. society. The extraversion of U.S. society leads practitioners and theoreticians to put more emphasis on what is said than on what is left unsaid or cannot be said in psychotherapy.”

(Kirmayer, 2007, p. 3, my translation)³

Language is a significant threshold for accessing the sessions. The fact that I speak only French inevitably determines the population with whom I can work: French-speaking people. Those who speak other languages—Wolof, Mandinka or Diola—cannot, at least at this stage, access the sessions, since there is no language mediator available to help me translate. This gives my intervention a very specific character. In practice, the people I meet in sessions are educated, and the hospital’s proximity to Assane Seck University will likely lead to a greater number of university students attending.

Over the course of two months, I conduct 25 initial consultations in total: 20 with women and five with men.

Following the initial introductory session, 12 cases end after the first meeting, without further care being initiated. The remaining 13 people—11 women and two men—begin a course of five additional sessions.

Below are some figures taken from the final report.

The age range is broad, from 18 to 60, with a greater concentration among younger people and young adults.

The overall mean age is approximately 34.3 years. Women have a slightly higher mean age than men (34.6 compared with 33.2 years). Analysis by type of intervention reveals a significant difference: the mean age is around 26.4 among those who undertake the structured psychological programme, whereas it rises to around 41.3 among those who attend only the initial consultation. This suggests that younger people are more likely to take part in ongoing support, while older people are more concentrated among those whose care does not continue beyond the first meeting.

The treatment involved predominantly young people aged between 18 and 25, including university students and young workers from a range of professional fields. The issues raised by this age group highlighted tensions in family relationships, particularly in polygamous households, including jealousy between brothers and sisters belonging to different branches of the family. Their accounts revealed anger associated with the perceived impossibility of having a direct discussion with parents or other adults in positions of authority. Within a system where generational hierarchies shape roles and responsibilities, expressing one’s point of view and negotiating conflict can become more difficult.

Another recurring theme was migration for educational purposes. In many cases, this involved moving between geographically close African countries. Because these migrations took place within the continent, they tended to be overlooked or regarded as less complex than international migration, largely because of an assumed smaller cultural and linguistic distance. Yet they held crucial significance for the people concerned, representing periods of separation and profound personal transformation that had substantially shaped their life journeys.

In the present, participants described a sense of loneliness, alongside individual strategies for managing distress. In some cases, these included the use of substances (including Taba-ba⁴ and yamba⁵) and online gambling.

I will discuss the findings in greater detail elsewhere. What I want to focus on here is how, alongside the work carried out within a structured setting—defined by dedicated spaces and regular sessions—informal conversations that took place during these three months outside the “therapy room” also played a central role in gathering this material.

Spending time in the afternoon or at the end of the working day at the clinic entrance, where the guard prepares tea for anyone who wishes to stop and talk, or in the green areas surrounding the small huts, enabled me to build relationships and hear people’s experiences in a way that strongly recalled my community psychology work with colleagues in Turin.

This way of working has its roots in street psychology, understood as an accessible, non-stigmatising presence in the places where everyday life unfolds. From this perspective, intervention does not necessarily begin with an explicit request for help or the start of a therapeutic process. Instead, it grows out of a willingness to share people’s everyday environments and create opportunities to meet. Through the continuity of these moments and informal interactions, a relationship of trust can develop, allowing the professional to be recognised as a familiar presence even before becoming someone to whom a person might turn for help.

The clinical dimension does not disappear; rather, it is redefined within a broader perspective. The therapeutic function remains central while opening itself to the possibility of meeting others as they truly are. The relationship is built not only on professional status but also on the ability to recognise and welcome the human dimension of the encounter.

In this sense, the therapeutic setting is no longer confined to a clearly delimited physical space. It is reshaped by a continuous presence in the places inhabited by the community and by the quality of the encounters that can develop there.

Psychological intervention thus becomes a process that unfolds before, during and beyond the consultation, recognising the value of what emerges in seemingly ordinary exchanges and shared everyday experiences.

Here are some reflections I noted in my ethnographic diary one morning after a night shift:

“The night-time perspective brought certain things into focus that now seem clearer to me.

Away from their respective consulting rooms, in informal situations, caregivers seem to develop a different quality of listening: more open and less directed towards finding an immediate answer. By taking off their uniforms, they attune themselves to a field that their professional roles tend to shield them from, making a more authentic closeness to others possible. Patients, staff and family members set aside the specific institutional identities that define them and meet primarily as people. What they share, then, is not the role each one occupies, but the possibility of engaging with one another from a common human condition. The therapeutic dimension is not exhausted by the spaces formally designated for care; it can also emerge in the folds of everyday life, where forms of recognition and belonging are built.”

(3 April 2026, ethnographic diary)

In this regard, I am reminded of a phrase Mariano quoted during the first training day, attributing it to Fritz Perls: “I did not invent Gestalt; Gestalt was already there” (Isha Larry Bloomberg, 1985, Vignalino). In other words, theory does not invent a phenomenon; it brings it into sharper focus.

If this is so, then the issue is not simply that Émile Badiane lacks psychotherapy. Rather, the question is what idea of psychotherapy we have in mind when we observe its absence.

If we understand it as a recognised profession, then certainly: it is not present here.

But if we think of it as attention to the relational field, as the ability to notice what emerges in informal interactions and in the dynamics that develop between people, then the picture becomes more complex. The challenge ahead is therefore not simply to introduce psychotherapy into a context where it is not yet recognised, but to reflect on the transformations this discipline might undergo when considered outside traditional models.

The Émile Badiane project is only just beginning. The process itself, as it unfolds, will reveal which questions emerge and what direction psychotherapy might eventually take within this new setting.

When asked why he described the practices of traditional healers as psychotherapy, Nigerian psychiatrist Thomas A. Lambo replied in an interview conducted in the 1990s by journalist and writer Thomas A. Bass, later published in the book *Reinventing the Future*, that “psychotherapy takes many forms.”

One question therefore remains open: what form will psychotherapy take within the Kénia hospital, and what might this encounter allow us to understand about psychotherapy itself?

NOTE

1. Original quotation in French: “La thérapeutique est essentiellement fondée sur la vie communautaire dans un lieu où le malade est accepté, écouté, reconnu dans sa personne. Chaque habitant peut être, par son écoute et l’attention qu’il prête aux autres, un thérapeute pour chaque malade. L’équipe soignante a pour objectif principal de susciter et d’animer cette vie communautaire; il s’agit moins de traiter au sens médical du terme que de permettre au malade de s’exprimer, d’être écouté, considéré, valorisé; de permettre à chacun de discuter, avec tous les autres, ses problèmes et de partager les activités de tous.” (Collomb, 1978, p. 114).
2. “Because I am a psychiatrist, and psychiatrists don’t do any more than this, even in New York City. In fact, they do less because they have no time for you. Traditional healers spend a lot of time talking to their patients, getting medical histories. They hold psychotherapeutic sessions, either jointly or in groups, where they analyze dreams, dance, or perform ritual sacrifices. They burn incense and commune with spirits. They go into the patient’s home and place fetish objects in the corners to ward off evil spirits.” (Lambo, 1994, p. 71).
3. Original quotation: “Much of psychological theory and psychotherapeutic practice has been underwritten by implicit notions of the person in U.S. society. The extraversion of U.S. society leads practitioners and theoreticians to put more emphasis on the unsaid or unsayable in psychotherapy.” (Kirmayer, 2007, p. 3).
4. In Casamance, Senegal, Taba-ba (or simply “taba”) refers to a powder or paste made from tobacco, often mixed with other local ingredients (two plants, kankouran mano and koundinding), used predominantly by women as a “vaginal drug.”
5. Wolof term for cannabis.

Bibliography

1. Collomb, H. (1978). L’économie des villages psychiatriques. *Social Science & Medicine, 12*(1–2), 113–115. https://doi.org/10.1016/0160-7995(78)90027-8
2. Kirmayer, L. J. (2007). Psychotherapy and the cultural concept of the person. *Transcultural Psychiatry, 44*(2), 232–257. https://doi.org/10.1177/1363461506070794
3. Lambo, T. A. (1994). In T. A. Bass (Ed.), *Reinventing the future: Conversations with the world’s leading scientists* (pp. 70–82). Addison-Wesley.
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