Niger and the networks of psychiatry from 1950 to 1980

Before we attempt to reconstitute the history of daily life in Pavillon E, we must locate it within the regional and global history of African psychiatry during decolonisation. The former French military territory and then colony of Niger was not included in the territorial federation of French West Africa (Afrique Occidentale Française – AOF) until 1922. Thereafter, the colony developed under the supervision of federal health and social policies until its independence. Its late inclusion in the federation and its landlocked position increased the backwardness of colonial policies that were already not very dynamic from the start.Footnote ¹⁴ In terms of mental healthcare, the absence of any coherent federal policy continued through to 1938, when a specific, appropriate legal framework was created, setting up a psychiatric care service in AOF, which however would not be of much practical consequence.Footnote ¹⁵

The first psychiatric service in Niger slowly took shape at the end of the 1950s. It may be that it benefited, as was the case in Senegal,Footnote ¹⁶ from funding from the Fonds d’investissement pour le développement économique et social (FIDES), whose second plan (1953–1958) financed several psychiatric institutions in the region. Compared to Algeria or Madagascar,Footnote ¹⁷ or to the psychiatric institutions of certain very close British colonies,Footnote ¹⁸ this was very late in the day. Historiographical works on progressive movements in psychiatry and their connections on the continentFootnote ¹⁹ at the turn of various independences have particularly highlighted the initiatives of Thomas Adeoye Lambo in AbeokutaFootnote ²⁰ or of Henri Collomb in Dakar.Footnote ²¹ But in spite of the geographical and cultural proximity of Niger, one struggles to identify how the future Pavillon E might have fit into these dynamics. On the contrary, several indicators reveal divisions between the movements of ethnopsychiatry, present in Niger as early as 1954 because of an interest in spirit possession, and day-to-day psychiatry, which was nearly invisible. This situation was not unique for this period, where a majority of psychiatric services in the sub-region remained on the fringes of these reformist movements.Footnote ²²

While the Dakar School was at the heart of the first African networks for discussion and research in the field of psychiatry in the 1960s, in connection with their Anglophone predecessors, and, over the years, practitioners of all nationalities who had trained at Fann spread out to numerous services throughout the sub-region,Footnote ²³ Niamey seemed to remain detached from this movement during the first decades of existence of Pavillon E. The traces left by the psychiatrist Charles PidouxFootnote ²⁴ allow us to analyse how local and international structures related to each other. He seems to have worked in Niger as early as the 1950s, and then to have taken on the management of Pavillon E without it being possible to say at exactly what moment,Footnote ²⁵ and he is very present in the archives of Pan-African psychiatric conferences between 1958 and 1968.

His publications in Psyché, a Christian psychoanalysis journal, in 1955,Footnote ²⁶ clearly reveal his interest in ethnopsychiatry applied in Niger in particular (and almost exclusively within songhaï-zarma society).Footnote ²⁷ Inspired by the discovery of local sociocultural institutions – or, to use his own terms, of a ‘pre-scientific’ knowledge about madnessFootnote ²⁸ – Pidoux, through his research and clinical experiments, took part in feeding into discussions about the relationship between ‘madness’ and ‘culture’. Developing a Nigerien clinical case, he examined the resources of local therapeutic practices, and suggested that he was already known and respected by the region’s zima (healers). Several years later, he played an important role during the three inaugural meetings of a continental psychiatric network that aimed to build the foundations of an African psychiatry,Footnote ²⁹ which were organised in 1958 and 1959 in Bukavu, Brazzaville, and Antananarivo. He was involved in preparing these, then was their co-rapporteur, and gave several presentations. The way he is described confirms his academic background: we successively read that he was a ‘sociologist and psychiatrist with experience of Africa’, an ‘ethnopsychiatric director at the CNRS’, or a ministerial technical adviser. The areas he investigated were varied, ranging from the psychosociological aspects of possession rites to those of migration, via ‘traditional education’, encephalography, or religious practices.Footnote ³⁰

1965 saw the foundation of the Société de psychopathologie et d’hygiène mentale de Dakar (Dakar Psychopathology and Mental Hygiene Society), whose works and network built on those of the new journal Psychopathologie africaine and the beginning of post-independence Pan-African psychiatry congresses. At this moment, we meet Pidoux again, both publishing in the aforementioned journal in 1967, and taking part in the Dakar symposium in 1968 (the second after Abeokuta, Nigeria) as a representative of Niger. Here again, he gives numerous presentations.Footnote ³¹ We then lose track of him during the following gatherings, in which he does not seem to have taken part, in particular the 4th Pan-African Psychiatry Conference that was held in Abidjan in July 1975, or the 7th International Seminar of the African Association of Psychiatry in Yaoundé in October 1977.Footnote ³²

Thus, while Niger was represented, first conceptually and then officially by Pidoux during these years that saw the structuring of the field of post-colonial African psychiatric research, the only hospital service in the country that took in patients suffering from mental illnesses does not appear to have benefited from these changes. In the parts of his writingsFootnote ³³ that we are still able to read today, nothing specifically refers to psychiatric care in Niger, or even to Niamey Hospital,Footnote ³⁴ as if the ethnopsychiatric approach had no place within this institution. However, discussions of these international meetings are very often connected with the fundamental issues that also affected Pavillon E in its early years: how to train African psychiatrists, the difficulties encountered by the discipline in ‘developing countries’, sociotherapy, therapeutic villages, etc.

This disconnection seems to become clearer when we examine the concrete situation in the service in the middle of the 1970s, when Pidoux was at its head. The dissertations written by students of the Ecole nationale de santé publique who took part in internships under the supervision of the head doctor, express – with a freedom probably connected to their position within the institution – the fact that the only psychiatrist in this service was often absent, being notoriously busy:

In the second half of the 1970s, transnational psychiatric networks, encouraged by the WHO, underwent a new development: from regimes of experts mainly focused on research and training, these movements tended to shift towards a mode of political advocacy which, in particular, encouraged the definition of national programmes in favour of ‘mental health’.Footnote ³⁶ However, it remains difficult to define the contours of this development in Niger, even if it seems that the psychiatric service did start to undergo such a process under the military regime of Seyni Kountché.

The latter seized power in Niamey in April 1974 following a putsch which no one seemed to have anticipated:Footnote ³⁷ the Supreme Military Council carried out a great populist clean-up of what they denounced as corruption in the Hamani Diori regime, which had been in power since independence and was on its last legs. S. Kountché’s long stint in power, through to his death in 1987, in its turn developed into an authoritarian regime with successive waves of repression, even if it is commonly viewed by the population as a period of revitalisation or even of modernisation, which supposedly also included mental health.Footnote ³⁸ Several accounts insist on the desire for change that is connected with the Kountché period, one of the tangible elements of which was the project to create an independent psychiatric hospital on the outskirts of the town: developed around 1975, this project was included in the five-year plan but was not realised for financial reasons.Footnote ³⁹ The way in which Osouf describes the project and its definition illustrates the conflict between the two views of psychiatry, which largely co-existed in the sub-region at this point:

Furthermore, Dr Sadio Barry explains that: ‘Kountché demanded modernisation. He asked the WHO how to proceed, and an expert (…) came to Niger. A Mauritanian, Dia. He wrote a document in which he said that what we were doing in Niger was anything but psychiatry and that the service was a menagerie: “a pigsty”. This very much upset the president’.Footnote ⁴⁰ We see here the tensions at work between the desire for modernisation and the dissonances between political government and government by ‘experts’. The fact remains that the assignment of a taskforce, sent over in the WHO’s name, and directed by the Mauritanian psychiatrist Al Houssein Dia to advise the government of Niger regarding the development of a national mental health service, took place in this context.

The ‘Dia Report’ is the missing link that might have allowed us to better relocate the history of the service within the context of regional interactions and to understand the efforts by the AFRO Group within the WHO to encourage co-operationFootnote ⁴¹ in the field of mental health. It could also have helped to analyse relations to the Dakar School, since Dia too had been trained at Fann a few years earlier.Footnote ⁴² Although this report has disappeared – even from its author’s own archive – we know for certain that the assignment did in fact take place in 1983.Footnote ⁴³ He recalls the discussions that were held with the Nigerien committee responsible for developing new solutions by insisting on his radical opposition to the project of building a new hospital:

He reports having been extremely shocked by the state of Pavillon E, in particular by how overcrowded it was and by the staggering number of chronically ill patients, but also by the living conditions of patients locked up in the ‘cabanon’ or ‘hut’: naked, on the bare ground, having sometimes been kept there for decades, and facing problems with the supply of basic medicines. He also mentions that a French psychiatrist was also present, but that he seemed to him to be ‘very distant’, as if uninterested in these issues.Footnote ⁴⁵ It is unlikely that this was Osouf, who like him had trained in DakarFootnote ⁴⁶ and with whom he would have had to communicate, but we do not know at what date Osouf left Niamey.Footnote ⁴⁷

These lines have inspired the hypothesis that Niger – or at least the psychiatric service of its National Hospital – was considerably out of step with prevailing networks of thought on an emancipated and emancipating African psychiatry, giving the impression of a graft that did not take. The criticisms formulated in the early 1980s reveal something resembling a yawning gap between the situation in Pavillon E (or in the Kountché government’s projects for mental health services) and the progressive movements arising out of the Dakar School or Pan-African conferences. They also give the impression that time stopped in the service, blocked in a kind of ‘asylum-based’ psychiatry that is often somewhat quickly associated with the colonial moment and which nevertheless remains to be defined. Going back into the normal operation of the service, its development and transformations, its daily life, in spite of the grey areas due to rare and fragmentary sources, allows us to resituate Pavillon E within a more finely grained temporality, and to reinsert it into the complexity of practices that were applied at the service during the 1960s and 1970s.

Daily life at the service: an exploration (1952–1983)

Challenged by Osouf’s article, we here intend to undertake the work of reconstituting the infrastructures, functioning, and staff of the service, from the 1950s through to the arrival of Sadio Barry in September 1983. Elements gleaned from ENSP dissertations (mainly internship reports written by nursing or social work students), the hospital’s admission registers, as well as reports provided by professionals, allow us to trace the contours of the service. In so doing, we reveal a more nuanced picture, with the opening of a dedicated service at the turn of independence, which in spite of all its limits provided the conditions for a fundamental break with the previous situation. Yaro Goumandeye, the first psychiatric nurse in the country whose career among the ‘madmen’ extended from around 1953 to 1982, was a pivotal figure of mental assistance in Niger throughout this period. The pioneering work of F. Saint-Girons, founded in particular on extensive interviews with this now deceased witness, allows us to reinterrogate the chronology of this care and its nature: the service was created at the turn of independence, but did not break with the strategy of locking up mentally ill patients.Footnote ⁴⁹ Nevertheless, Y. Goumandeye reports a variety of practices based on a pragmatic vision for the reinsertion of patients into a social web, which can in fine be viewed as therapeutic – despite the limitations in the care provided that can otherwise be observed. Furthermore, the service had routines, activities which gradually became established, and its functioning was integrated into the wider logic of the National Hospital – with all of these being elements which also ‘held’ and ‘contained’ the patients. Reconstituting this history of the daily lifeFootnote ⁵⁰ of Pavillon E, through its first years of existence, allows us to start asking the question of what constitutes a transformation.

At the start of the 1950s, Niamey had, as well as the hospital created in 1922, a ‘central dispensary’ connected to several healthcare infrastructures on the periphery of Niamey and working under the supervision of the French army physician directing Niamey Hospital. The most ‘dangerous’ or undesirable mentally ill patients were then treated in a few rare closed spaces connected to the dispensaries, whose aim was to keep them locked up.Footnote ⁵¹ The control of ‘madmen’ in urban spaces was structured, as it was elsewhere,Footnote ⁵² around police actions targeting populations that were viewed as undesirable, which were regularly ‘rounded up’ – but there was a definite lack of dedicated spaces in Niamey: in 1952, we can find only two spaces that were able to receive ‘lunatics’, a ‘hut’ at the dispensary and an ‘isolation room’ at the hospital.Footnote ⁵³ Yaro Goumandeye started to shuttle back and forth between these two places of relegation for the treatment of ‘madmen’ from 1953.Footnote ⁵⁴

In terms of infrastructure, apart from the two places mentioned in 1952, one of which was reserved for women and the other for men, the system’s capacity changed around 1955: during an extension of the hospital, a ward was built on the first floor of the building closest to the main entranceFootnote ⁵⁵ in order to cater to mentally ill patients; and in parallel, Pavillon E was built, a general medicine service for various categories of civil servants. This then became a psychiatry pavilion between 1960 and 1962, with the space being partitioned: the ground floor was reserved for mentally ill patients and the hut, and above it was the general practice for civil servants.Footnote ⁵⁶ During the second half of the 1960s, Pavillon E was extended and divided into two parts: one for men and one for women, who were then transferred to the ground floor: it was necessary to prevent sexual abuse and, more generally, patient sexuality.Footnote ⁵⁷ The space reserved for the general hospitalisation of civil servants now catered to a new type of patient:Footnote ⁵⁸ common law or political prisoners, who were brought here from prison when they required medical care (usually of a non-psychiatric nature).

The presence of undesirables who had been ‘rounded up’ on the street, or of political prisoners, near the psychiatric service, reveals,Footnote ⁵⁹ subsequent to colonial policies, the governmentality of madness and the post-colonial decisions made in terms of political and social rights. Niger became independent in 1960, following a process close to that undergone by other colonies in the group formed by former French West Africa, and which was in particular rife with political manoeuvresFootnote ⁶⁰ through which France did everything to enable the access to power of the elites with whom it had good relations.Footnote ⁶¹ This was the case for the first Nigerien president, Hamani Diori, whose authoritarianism was reinforced by the consolidation of the (PPN-RDA) party-state and the ferocious repression of the Sawaba opposition movement.Footnote ⁶² The regime worked in harmony with Paris, which for many years provided it with numerous experts in all the fields of administration, healthcare, defence, and security. This so-called moment of national construction is the one for which we most significantly lack documentation about the psychiatry service and, more broadly, about the history of healthcare in Niger.Footnote ⁶³ Nevertheless, we can identify a form of continuity of practices with the colonial period, or even of reinforcement of these practices, with the creation of a dedicated psychiatric service: the ‘undesirables’ who were regularly removed from the public space for reasons of public order, and the prisoners who had to be kept locked up and monitored while they received medical care, were associated with hospital-based psychiatric practice and stigmatised this practice. Osouf again writes about the presence of prisoners in the service in 1980, which ‘consecrates the very detrimental assimilation of hospitalisation for mental illness with penal incarceration, both in the eyes of the public authorities and general public opinion’.Footnote ⁶⁴

Another central continuity after independence was Goumandeye’s involvement as a native nurse. Given the inadequacy of the healthcare system and the lack of local staff, he already enjoyed a relatively considerable autonomy in relation to French military doctors in the colonial period,Footnote ⁶⁵ and he continued to be the main daily figure for patients and staff when he was supporting psychiatrists who now tended to be coopérants. Trained as early as the 1940s in the first institutions aimed at native healthcare staff,Footnote ⁶⁶ the career of Goumandeye is striking. He became the first psychiatric nurse after specialising at Fann around 1960, as well as having a family heritage which, according to him, allowed him to ‘treat diseases of the spirit’.Footnote ⁶⁷ The length of his presence at Pavillon E makes him a central figure of post-colonial psychiatry, since he retired in 1982 after having been a major figure for many years – a genuine kingpin of the service, the doctor’s right-hand man, head of staff, administrator of reserves. Following the official creation of the service under the guidance of Dr Tchelle,Footnote ⁶⁸ the system structured around the duo of a Nigerien nurse and a French doctor endured. Upon returning from Dakar, Goumandeye started to work with the first in a long series of ‘coopérant’ psychiatrists, who he called Dr S. Up until the arrival of Patrick Osouf at the end of 1978, it is difficult to establish a precise chronology of the presence of these doctors and their identity: S., Charles Pidoux, Alain Bertrand, and other anonymous figures passed through the head office of the service during the 1960s and 1970s. For a long time, this office remained by the entrance to the hospital, which reinforces the impression of there being a disconnect with the daily life of a service that quickly became overcrowded and which was becoming increasingly stigmatised.

The organisation and daily life of the service largely appear in the dissertations of student nurses from the second half of the 1970s: they are particularly critical, which suggests that there was probably a consensus among the staff regarding certain practices that were viewed as inhumane and associated with the 1950s, in particular for ‘agitated’ patients who were locked up in the ‘hut’. However, no cause or responsibility is pointed out – we just observe a lack of resources, expressed through the use of the still powerful rhetoric of underdevelopment. The main criticisms are targeted at the lack of qualified staff: only one doctor, a head nurse who was the only specialised nurse, and a number of nurses that increased from two to five between 1974 and 1979, as well as around ten subordinate staff ranked as ward housekeepers, unskilled workers, caretakers, and ‘boy cooks’. They also point out the dilapidation of the premises, the dirtiness, the dangerous electrical system, the defective toilets, but above all, the poor quality of the food given to the patients in largely insufficient quantities. Mealtimes are particularly observed and criticised: there are not enough vegetables, fruit, or meat, and the rations are too small. Foreshadowing the observations of the Dia Report, a student writes in 1976:

In a context of constant overcrowding, the impossibility of providing care was then passed down in a domino effect: the psychiatrist head doctor had to treat the patients as well as the prisoners, but he only rarely saw them, since there were too many of them; the head nurse was responsible for supervision and administration as well as for providing care in the ‘hut’, and also had to monitor treatments, make observations, and signal issues to the doctor if need be; nurses worked in three 8-hour shifts and the head nurse during the day only. Nurses were sometimes left alone during the night with almost 200 patients; they therefore had to be able to rely on the ward housekeepers. The daily life of patients in Pavillon E, most of whom, it is specified, were brought in by the police during this period, and more rarely by their families,Footnote ⁷⁰ was even more difficult for the category of so-called ‘indigent’ patients, who had no known parents, or whose families were not able to provide any additional support.Footnote ⁷¹ A particularly vehement dissertation from 1979 even mentions that, unlike those who received their care in bed, these patients were treated in a common room, with the same syringe and often the same needle for injections – and by a ward housekeeper.Footnote ⁷² This author concludes:

The admission registers for Pavillon E that have been partially retrieved for the periods 1966–69 and 1975–79 allow us to define some general trends in hospitalisations during these first two decades of the service’s existence. The number of people admitted to psychiatric hospital per year increased considerably and regularly, going from an average of around 400 in 1967 and 1968, to 500 in 1975, and reaching 650 in 1978.Footnote ⁷⁴ But this does not reveal how many patients were present at the same time in a service that only included around a hundred beds. Student dissertations confirm the overcrowding which Osouf condemned: at the beginning of their internships, they mention 202 patients in 1976, over 230 in 1979, 194 in 1980, and 220 in 1981.Footnote ⁷⁵

While Osouf wrote the first critical scientific article on psychiatric care in Niger, students on internships in the 1970s had uncompromisingly documented the living conditions of patients and staff. When Osouf arrived, the service was more overcrowded than ever and staff numbers were extremely low: a total of 8 people for 250 patients, he writes, which amounted to – due to the timings of shifts and breaks – an average of one nurse for 50 people.

The doctor’s opinion on the quality of the work carried out and the possibility of providing therapeutic care is final. However, the account of a psychologist doing an internship in the service at the same time, Patricia Brossat,Footnote ⁷⁷ as well as that provided by head nurse GoumandeyeFootnote ⁷⁸ throughout his long career, allows us to glimpse some instances of genuine care work being carried out. We see here the possibility of bonds being created, in particular with chronically ill patients, kindnesses that go beyond the walls of the hospital, and an ability to allow ‘traditional psychiatry’ practicesFootnote ⁷⁹ to exist alongside sometimes punctual admissions to the service. Collective activities, already referred to as ergotherapy,Footnote ⁸⁰ and which allow certain patients to make artisanal objects that are then sold at the National Museum, thus generating a little revenue for them;Footnote ⁸¹ organised days of collective cooking in the women’s space, thus recreating the more familial atmosphere of a large traditional household;Footnote ⁸² and above all, the largely informal and constant nature of the relatively free communication between all players in the service, from doctors to patients, through the head nurse, interpreters, or ward housekeepers and caretakers.

Patricia Brossat, while she does not shy away from describing difficult scenes that also reflect some terrible conditions, in particular those of being locked up in the ‘hut’, ultimately almost paradoxically reveals the humanity and care that are also part of daily life in the service: people communicate and sometimes even heal.Footnote ⁸³ Although they had already been implemented for years under Goumandeye, practices resembling sociotherapy seemed to consolidate during Osouf’s time at the service – albeit carried out with whatever means were available and despite the overcrowding of the service. Dissertations by ENSP students largely bear witness to this from 1981, which was also the year that saw the arrival at the service of its first social worker, Georgette Guillemin.Footnote ⁸⁴ All of this thus outlines the subtlety and diffuse aspects of the transformations underway during this second decade of existence of the Niamey psychiatric service.

Psychiatric logics that might seem contradictory co-exist side by side, reflecting a daily life in evolution. Logics of solidarity and care can thus emerge in a generally rudimentary context driven by asylum logics. However, as we will see, the history of the service, conveyed locally by different generations of caregivers, is less nuanced. It highlights a radical transformation of the service under Dr Barry, clearly marked as a ‘before and after’ between the asylum model and the advent of modernity.

The ‘Barry Revolution’: oral history and historicity of Pavillon E

Pavillon E’s complex history is also the object of oral history deployed in the informal transmission of knowledge between service personnel. This history is marked in particular by a ‘revolution’, a crossing point towards a new era of psychiatry in Niger. (Re)constructing a historiography of the service implies indeed examining the local discourses produced and transmitted by medical and hospital staff which underwent a break with the arrival of Dr Sadio Barry. While, in a relatively uniform manner, the population viewed Pavillon E as the symbolic location of ‘madness’ in Niger,Footnote ⁸⁵ the generations of healthcare workers who worked here one after the other, for their part, became acquainted with more complex and detailed chronological narratives. Reports from staff members from this period constitute an essential resource to be collected, reproduced, and interrogated as a source. It is also a constructed knowledge conveyed by Dr Barry and his nurses, Awa Sylla and Idi Kona, that needs to be situated. The chronology in these oral histories seems to be relatively stable and constructs the ‘revolution of Pavillon E’ led by Barry and his team as a fundamental break in the history of the psychiatric service. This turn, viewed as ‘modernist’ by these staff members, radically defined a before and an after ‘Barry’, a transition from the age of barbarity instead of care and a profound recasting of the relationship of local psychiatry to mental illness under the belated influence of Fann, as embodied by Barry.

This psychiatrist, recognised as the figure who reformed psychiatryFootnote ⁸⁶ in Niger both on a local scale and within West African mental health networks, more assertively exported certain principles of the Dakar School, which up until that point, Pavillon E had probably only slowly started to benefit from. Trained at Fann in the 1970s in medicine and then in psychiatry, and originally from Guinea, Dr Barry emigrated to Niger for personal reasons, and definitively settled there in 1983. He became the first African psychiatrist in the country, and adopted the position of spearhead of the sector in a context where, like a mirror of Dakar, here everything still needed to be done and (re)thought. Accounts of this pivotal moment, provided by Barry himself and by the staff working between the end of the 1970s and the decade of the 1990s (head nurses of the service, nurses, caretakers), and then taken up again by those who came after them, present this turning point as a movement of massive transformations. They oppose this to the ‘dumping ground’ that pre-existed up until this point,Footnote ⁸⁷ where ‘madness’ was synonymous with bestiality, with being locked up in the ‘hut’, where the ‘madman’ was subjected to retrograde mental health treatments. This earlier period is viewed as anachronistic and is conveyed as such through the crudity of the treatments inflicted on mentally ill patients, which are supported by the traces of an architecture inspired by the carceral aspect of (post-)colonial psychiatry:

The hut and its vestiges – a huge metal fence enclosing the space – bear witness to the imprint of the poor treatment inflicted on patients who were described as ‘madmen’, ‘animals’, and ‘beasts’ to underline the whole dehumanising character of this logic of the asylum.

The reformers’ accounts, through their rhetoric and the vocabulary they employ to refer to the so-called ‘asylum’ period, re-emphasise this caesura. Indeed, they always frame as a chronological counterpoint their descriptions and comments on a series of reforms aiming to liberate the ‘madmen’, at relieving the service from an overpopulation of indigents, at favouring, instead of surveillance, medicalised care similar to that provided in the hospital’s other services. The before and after are described in all aspects – architectural, medical, and organisational – highlighting how and by what means this anachronistic service was transformed into a psychiatric pavilion that was worthy of the name.

Through the narratives provided by staff members, we see that this ‘revolution’ is based above all on a principle of humanisation of psychiatric care and, as such, of the patients themselves. The ultimate act was the liberation of the ‘madmen’ from the hut, which gave back a common humanity to both caregivers and patients. The heart of this reformative movement unfolded around categorically challenging the idea that mentally ill patients were naturally aggressive. Although a cross-reading of oral and written sources rather forces us to temper the radicalness of this turn by taking into account the logics that were already at work before Barry’s arrival, the fact that these discourses represent institutional violence as the tipping point for this new local psychiatric policy shows the importance of this ideological change, in which treating bodies through confinement became obsolete:

These changes were pushed forward by certain principles from reformative movements in post-war psychiatry and in post-independence social therapy, and were situated at a crossroads with the increasing influence of global mental health.Footnote ⁹⁰ They were faced with some resistance, but also aimed to reintegrate mental health patients within the (human) community:

This process of opening up closed spaces – dating back to 1985 for the hut, and unfolding more progressively through to the end of the 1990s for cells reserved for common law prisoners – was in fact accompanied by a reinforcement and transformation of the medicalisation of medical practices. While the practice of ‘biological’ psychiatry was already germinating in the service, Barry and his medical team accompanied and supported the liberation of the patients in the hut through an institutional openness to neuroleptic molecules offered and supplied by French laboratories. Like with other post-colonial contexts, the logics of sociotherapy were in fact supported by a therapeutic reformFootnote ⁹² which locally enabled a control over patients that was necessary for the wider process of relieving the service:

The introduction of new pharmacological treatments, in particular extended-release neuroleptics known as ‘depot neuroleptics’, also supported a process of reorganising care. A recasting of the mandate of psychiatry was at work in this movement. The apparently more assertive resistance against forces responsible for social control and the monitoring of undesirables (prisoners, dangerous madmen, indigents, vagabonds) appears in these accounts as one of the main motivations for a pitched battle against the official authorities, at the level of the hospital, of police services, or of the government of Seyni Kountché up until 1987:

The positioning of staff members during this period in favour of the medicalisation of psychiatric care led to a transformation of connections to external services – in the hospital, police, and penitentiary systems – as part of a process that is in fact still at work in the contemporary period.Footnote ⁹⁵ Nevertheless, the decades of the 1980s and 1990s seemed to considerably contribute to a transformation of the views of psychiatry at the hospital level via the institutionalisation of day-to-day practices which up until that point tended to be the result of isolated initiatives.

As such, the family occupies a central place in this reform. Once more influenced by clinical standards in Fann, where the role of a patient’s relatives in hospital had become central to their care,Footnote ⁹⁶ this new generation of staff established the rule that a family member – an ‘accompanier’ – must be present during the patient’s stay in hospital. Beyond clinical dynamics, this prescription avoided the patient being left entirely under the responsibility of the service, in order to support relieving the service for chronically ill patients, while constituting an additional resource against the service’s shortcomings:Footnote ⁹⁷

As well as using these new rules to regulate the presence of clients in the psychiatry service,Footnote ⁹⁹ the team’s activities also aimed to make the service more hygienic. On this subject, eyewitness reports describe a process of cleaning up premises and bodies and, it also seems, symbolically cleaning up the dirt of the previous decades and the forms of ignominy still associated with them to this day:

This process of creating a distance from madness in the asylum was actualised through ‘crackdowns’: the cleaning of spaces with soap, as well as of the patients staying in them, was directly correlated to the ‘(re)birth’ of Pavillon E:

Staff members’ reports agree on defining the Barry period as the starting point of a major change in the way mentally ill patients were cared for in Niger, within a landscape that was seen as lacking in solidarity and which up until that point had tended to go against the principles defended by the avant-garde. Through this process, Niger symbolically became part of this movement of social and community psychiatry. However, Dr Barry and his team also took this approach because they were disillusioned with realities that could not be denied: the aim was above all to turn Pavillon E into a medical service like any other. Reports from the time are important to follow the content of ideological and clinical changes that left a more visible mark on the landscape of local psychiatry at the time – even if it already provided fertile ground for these institutionalised transformations. But this period, which was then collectivised and transmitted to later generations, also acquired an obvious symbolic as well as performative force: that of bringing Pavillon E into ‘modernity’ through these narratives.