Culture, Medicine, and Psychiatry

, Volume 43, Issue 4, pp 663–685 | Cite as

Falling, Dying Sheep, and the Divine: Notes on Thick Therapeutics in Peri-Urban Senegal

  • Anne M. LovellEmail author
  • Papa Mamadou Diagne
Original Paper


Peri-urban Senegal lies outside the influence of both the nation’s historic public mental health model and contemporary global mental health. This paper examines how cultural logics in this underserved region spill over from social domains to widen the therapeutic sphere of psychoses and epilepsy. Observations and 60 carer and/or patient interviews concerning 36 patients afflicted by one or both conditions illustrate how the “crisis of the uncanny”, a spectacular eruption of psychoses and seizures into the everyday, triggers trajectories across these domains. To resolve the crisis, patients and carers mobilize debts and obligations of extended kin and community, as well as a gift economy among strangers. The therapeutic and non-therapeutic are further linked through the semantics of falling, which associates this local term for the crisis with divine ecstasy and the slide from human to non-human forms of life. We introduce the concept of thick therapeutics to capture how the logics of sheep- other animal-human relationality, secular-divine politics of giving, and payment/sacrifice for healing imbue a therapeutic assemblage continually constructed through actions of patients, carers and healers. We ask what implications therapeutic thickening might have for mental health futures, such as monetized payment under global mental health.


Psychosis Epilepsy Eruption of the uncanny Thick therapeutics Senegal 



We thank Dr. Jean Augustin Diegane Tine for his valuable advice throughout the study. Cristiana Giordano, Helen Regis, Ursula Read, Claudia Lang and Sue Makiesky Barrow provided incisive comments. Thanks also to Didi Goldenhar and Bill Kornblum for their feedback and écoute.


Research for this study was funded by the Agence National de la Recherche (ANR-13-BSH1-0009-01) and the European Research Council (340510).

Compliance with Ethical Standards

Informed Consent

Research for this paper was approved by the Comité national d’éthique et de recherche en santé (CNERS) of Senegal. Informed consent was obtained accordingly from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.INSERM and CERMES (Research Center for Medicine, Health, Mental Health and Society) - UMR 8211ParisFrance
  2. 2.CERMES (Research Center for Medicine, Health, Mental Health and Society) - UMR 8211ParisFrance

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