Culture, Medicine, and Psychiatry

, Volume 38, Issue 3, pp 427–447 | Cite as

Of Shifting Economies and Making Ends Meet: The Changing Role of the Accompagnant at the Fann Psychiatric Clinic in Dakar, Senegal

  • Katie Kilroy-MaracEmail author
Original Paper


Since 1972, inpatients at the Fann Psychiatric Clinic have been required to have a family member or close friend—an accompagnant—stay with them for the duration of their hospitalization. In recent years, however, the role of the accompagnant has seen a dramatic transformation. This article considers the emergence of a new kind of accompagnant at Fann: the for-hire accompagnant mercenaire, who is unrelated to the patient and not employed by the clinic. Against the backdrop of Senegal’s neoliberal turn and in light of the growing prominence of the biomedical approach at Fann, the author shows how the idealized accompagnant model of family caretaking has given way to this new form of commodified care. At the same time, however, the author argues that accompagnants mercenaires regularly draw upon and establish new sets of moral codes, obligations, debts, and expectations in their day-to-day interactions with patients, family members, and staff alike. By way of a careful ethnographic examination of the evolution of the accompagnant role at Fann, this article brings into focus a complex and multidimensional picture of the shifting economies—moral and political, as well as therapeutic—within the present-day clinic.


Psychiatry Care Moral economy Therapeutic economy Neoliberalism 



This research was funded by a Fulbright-Hays DDRA Fellowship Award and a Columbia University Travel Grant. A Zeising Award from Sarah Lawrence College allowed me to revisit Fann in 2013. I am grateful to Amira Mittermaier, Kristen Drybread, and Jenny Sime for their helpful suggestions on earlier drafts of this manuscript. I also thank the anonymous reviewers of Culture, Medicine and Psychiatry for their constructive feedback and support. Finally, my deepest gratitude goes out to Fara, Coumba, and so many others at Fann who have generously shared their stories with me over the years.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.University of Toronto ScarboroughTorontoCanada

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