Reviewed Book
An Impossible Inheritance: Postcolonial Psychiatry and the Work of Memory in a West African Clinic, Katie Kilroy‐Marac, Berkeley: University of California Press, 2019, 269 pp.
The Fann clinic in Dakar, Senegal, and the work of its first director, Henri Collomb, have a central place in the mythology of transcultural psychiatry. For psychiatrists and anthropologists who questioned the universalism of psychiatric science, the “école de Fann” offered a tantalizing alternative. Bringing local models of madness, spirit possession, and healing together with psychodynamic theory, Fann promised new approaches to understanding and responding to mental distress, attuned to the particularities of the African context.
In this volume, anthropologist Katie Kilroy-Marac provides a careful, nuanced, and deliberately inconclusive account of Fann, revealing the nostalgia that imbues this reverie. Deploying theories of memory, nostalgia, and haunting, she explores the “afterlives of Fann’s contested past.” The title’s “work of memory” references Freud’s “work of mourning,” the psychic labor following loss that, if incomplete, may turn to melancholia. Kilroy-Marac argues that the work of memory is always polyphonic and intersubjective; the past is “inexhaustible” in its interpretation. Yet a patina of melancholia runs through the book—the loss here a recognition that the past as it was imagined by the nurses, social workers, patients who worked with Collomb, as well as proponents of transcultural psychiatry, perhaps never was. Alongside nostalgia for the unfulfilled promises of postcolonial modernity may lie nostalgia for an alternative to the disappointments of Western psychiatry.
Combining exploration of the published archive, interviews with those who worked with Collomb and ethnography in the clinic, Kilroy-Marac’s account is based on research spanning two decades, from the end of the 1990s to her return to Fann between 2013 and 2017. The book’s chapters are punctuated by “interludes” and “ruptures,” four of which feature Demba, a former patient of Collomb, whose own fractured memories set up the contrast between an idealized past and a degraded present. In the intervening years, changes to the innovative practices at Fann, including the celebrated communal meeting, the “penc,” and the family “accompagnant,” are linked to the shift to a neoliberal economy as well as changes in the orientation of psychiatry globally. Privatised initiatives such as a VIP unit and drug rehabilitation program deepen inequalities, while subsidizing one of the most neglected sectors of a defunded public health care system.
In the opening chapters, Kilroy-Marac outlines the protracted debates of the French administrators, which meant that Fann was established only at the very close of the colonial period. The ethos of such model projects, established in the era of “welfare colonialism,” extended into the postcolony, taken up within the modernizing imaginary of the new nation state. However, whereas in Nigeria it was a Nigerian, Thomas Adeoye Lambo, who as director of Aro hospital established his innovative “village psychiatry,” Fann was headed not by a Senegalese psychiatrist, but by a French military doctor. Appointed in 1959, one year before independence, Collomb remained director for nearly 20 years. Both Collomb and Lambo aimed to develop a distinctly African psychiatry, located in ideas of African communalism, but their approach differed in fundamental ways. Lambo countered the inherent racism of colonial theories of “the African mind,” by claiming the universalism of psychiatric disorder. Collomb and his colleagues at the “école de Fann” drew on psychodynamic theory and ethnopsychiatry to articulate a culturally distinct experience of psychic breakdown.
Collomb himself is an ambivalent character whose journey from colonial medic to Africanist pioneer remains obscure. As Kilroy-Marac points out, Collomb’s friendship with Léopold Senghor, first president of independent Senegal, and the alliance of Fann with Senghor’s pan-Africanist philosophy of Négritude, does not extend into a radical political sensibility in the clinic. Indeed, as Kilroy-Marac outlines, over the period of Collomb’s directorship, Senghor’s formulation of Négritude shifted from an anti-colonial embrace of Africanist values to consider European “reason” an essential contribution to Senegal’s modernisation. Collomb remains a shadowy enigmatic figure, a ghost haunting the corridors of Fann, as one informant told Kilroy-Marac. We see him only through the memories of his contemporaries and his published academic works. There is no exploration of his personal archive, if such exists, the letters or diaries which might reveal his motivations and unpolished reflections.
Kilroy-Marac’s volume is thus not an exhaustive biography of “the man behind the legend,” rather it is an exploration of an institution and its legacy, uncovering the awkward and contested “back story,” the erasures and the traces that remain. Kilroy-Marac reveals the partiality of Fann’s memorialization: While celebrated for incorporating traditional healing rituals in the clinic, the routine use of psychopharmaceuticals and electroconvulsive therapy during Collomb’s tenure is overlooked. In the Fann clinic today, the imaginaries of African culture that secured Fann’s status within transcultural psychiatry sit at odds with the modernizing ambitions of Senegal’s 21st-century psychiatrists. Like Lambo before them, but in contrast to Collomb, they stake their claim to a universal psychiatry as the path to therapeutic efficacy, as well as inclusion within the global scientific community.
These tensions between universalism and culturalism have been given renewed energy in recent years with the rise of “global mental health.” The drive to scale up interventions in low-income countries has been critiqued for supplanting traditional African approaches with Western psychiatry (Cooper 2016). What is interesting is that, as with Collomb and his European colleagues at Fann, much of this critique comes from those outside Africa, not from Africans themselves. The historian Matthew Heaton has pointed out that the oppositional framing of such critiques overlooks the role African psychiatrists have played in the evolution of psychiatry, not only in Africa but worldwide (Heaton 2013). Far from being passive repositories of Western-generated knowledge, the first generation of African psychiatrists were active in exploring how they could adapt and shape psychiatry’s methods to the particularities of their own contexts.
Ultimately, Kilroy-Marac does not set out to resolve these questions, recognizing that they remain open and contested. Her concept of “impossible inheritance” references the legacies of colonialism that continue to shape debates regarding the practice of psychiatry in the continent. Psychiatry itself is perhaps also an impossible inheritance—a discipline that struggles to address the structural inequalities that lead to oppression, mental breakdown, and exclusion. Disillusioned by the neoliberal turn of the Fann clinic, Kilroy-Marac finds hope in the poems and artwork of Demba and the art therapy group she encounters in the hospital on her return. In this, she finds a space that is generous and open enough to hold the tension between the disappointments of the past and hopes for the future, offering care, connection, and companionship.
This book is a fascinating exploration of Fann and its legacy and an important contribution to the growing history of African psychiatry. However, as Kilroy-Marac acknowledges, this is inevitably a partial history whose gaps and absences raise other questions. The list of archives consulted consists of just a few in the national archive in Dakar. Perhaps one of the most significant absences concerns the perspectives of those healers who worked with Collomb. It is only by chance that Kilroy-Marac meets one, Daouda Seck, but by then he is on his death bed, so his memories are unrecorded. As some African psychiatrists and psychologists turn with renewed interest to the possibilities of partnering with traditional and faith healers, it would have been a valuable addition to hear their accounts of this early experiment. The story Kilroy-Marac tells suggests this too might prove an “impossible inheritance.”
References Cited
Cooper, S. 2016. Global Mental Health and Its Critics: Moving beyond the Impasse. Critical Public Health 26: 355–58.
Heaton, M. M. 2013. Black Skin, White Coats: Nigerian Psychiatrists, Decolonization, and the Globalization of Psychiatry. Athens: Ohio University Press.