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

摘要

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.