What forms does your work as a psychologist in Bamako take, and what structures do you work for?

I’m lucky enough to work in many different settings and with many different audiences! My practice is all the richer for it. First of all, I work as a consultant for the SAMU Social in Mali, which is responsible for reaching out to street children in precarious situations. In this case, my role is to reinforce the team’s resources, and to approach the complexity of certain situations from a different angle. I also run a storytelling workshop for children aged 5 to 11, in collaboration with a speech therapist in Bamako, Olivia Lefebvre. I also work in collaboration with the Centre Médico-Social and the Lycée Français in Bamako. Finally, I have a private practice as a psychologist-psychotherapist. In this context, I see four to five patients a day in my practice, both Malians and foreigners.

In parallel with your various activities, we can read on your blog about the setting up of a therapeutic workshop that is particularly innovative for Malian society…

That’s right! In addition to these regular missions, I also work with the Psychiatry Department of the Point G University Hospital, where I take part in therapeutic « koteba » sessions on a voluntary basis, as part of a research project (1) : This project began more than 25 years ago, when Professor Baba Koumaré, current head of department, had the brilliant idea of introducing an ancestral satyric theatrical tradition to the psychiatry department, in which individuals can verbalize their suffering, tell it like it is, without any taboos, and discuss issues relating to their daily lives or Malian society (such as arranged marriages, economic difficulties, family conflicts, polygamy, etc.). If this theatrical context is so beneficial to them, it’s because Malian society traditionally attaches little importance to the suffering of the individual as such. It’s a fact that the individual has little place. We could even say that he « doesn’t exist » without the social group to which he belongs. All importance is given to the group and the family. As a result, most of the time, only collective needs are recognized and considered by society, to the detriment of individual needs.

In my opinion, this is the main reason why psychotherapy is developing slowly in this country (in addition to the spontaneous recourse to the marabout in difficult situations for the majority of Malians). In the eyes of Malian society, it’s very rare for a Malian to take the time to listen to another Malian in pain; a practitioner-patient relationship that remains very essential in the West! It’s therefore easy to imagine the daily life of a Malian suffering from mental illness, and the benefits of such a theatrical context for his or her well-being, a context in which the emphasis is finally placed on individual claims. In my view, these workshops, which open up a dialogue, have a genuine socio-therapeutic purpose.

What psychology training have you taken?

My training began in Lausanne (Switzerland), where I graduated as a psychologist. That was just the beginning! I then went on to do a post-graduate course in social psychology at the University of Liège, followed by a specialization in emergency and disaster psychology with the Swiss Federation of Psychologists (FSP), before moving on toethnopsychiatry, systemic brief therapy, thePalo Alto school and Ericksonianhypnosis. This career path has enabled me to diversify my practice and color my therapeutic approach with different theoretical colors.

What approaches do you use in your private practice?

With my patients, I mainly use systemic, non-normative approaches. Because of the cultural gap, it would be difficult for me to resort to intellectualized psychological conceptions as would be the case in the West. As a result, I opt for an interactional approach, focusing on the individual in his or her environment. I try to get as close as possible to his feelings, to his way of seeing the world. I have sometimes used hypnosis orEMDR(Eye Movement Desensitization and Reprocessing), tools that have worked well with some of them. I’ve also noticed that certain Western practices exist in other countries around the world, but under completely different names! With this in mind, I’m always keen to adapt certain Western techniques to the African context.

Why did you come to Mali?

My keen interest in travel, different cultures and meeting new people naturally led me to work in the humanitarian field. It’s a human environment in which I flourish both personally and professionally. I first worked for an NGO in Geneva, then for the International Committee of the Red Cross and Médecins Sans Frontières. But the main reason I came to work in this country was to follow my partner, who has been transferred to Bamako. She is a diplomat with the Belgian Ministry of Foreign Affairs.

When you started out in Bamako, were you confronted with a certain « culture shock »?

Indeed, there’s a big cultural gap between Western and African culture, particularly in terms of religion and way of life. As a result, it took me some time to establish good relationships and gain the trust of Malians. It’s probably difficult to understand each other. I am supervised every week by an experienced Belgian psychologist.

It’s particularly through the words of my patients that I feel the weight of this cultural gap. Indeed, the suffering people who take the initiative of coming to see me are generally misunderstood by their loved ones. As I explained earlier, the individual’s feelings are of little importance in themselves, and listening to a person in psychological distress has little meaning for the vast majority of Malians, and therefore remains exceptional. My patients are sometimes quickly branded « crazy » by those around them. Moreover, the notion of individual responsibility is virtually non-existent. When an individual is healthy or successful, it’s thanks to his parents, his ethnic group or God. Conversely, when an individual falls ill or suffers from mental problems, it’s because someone has cast a spell on them. It’s easy to see why it’s extremely difficult to mobilize the suffering individual towards greater well-being in the context of psychotherapy. After all, they are not responsible for what happens to them (good or bad)!

However, for me, this clash of cultures remains something very positive. It forces me to take a step back from my own conceptions, and to be cautious in my practice. The cultural gap also has a positive impact on group work between caregivers. Sometimes, particularly innovative ideas come out of it! What’s more, to capitalize on this sharing of opinions, I try to formalize certain tools on a regular basis. In other words, I summarize in writing the different tools that the care team and I use with patients on a daily basis, specifying which ones seem to work and which ones are ineffective. It’s important to remember that Mali doesn’t share the same culture of the written word as the West, so few things are crystallized in black and white.

What psychological difficulties do you encounter in your patients?

Curiously, I find the same clinical pictures in my patients as I did in Switzerland and Belgium. Many of my patients are depressed, anxious and troubled. Some suffer from what we might call OCD (Obsessive-Compulsive Disorder), obsessive thoughts. However, while the clinical signs are much the same as those we might encounter in the West, the reasons for these difficulties are quite different! Depression, for example, often stems from an individual’s inability to express his or her needs, and to withstand the weight and pressure of the group. The individualization of a Malian – whether voluntary or involuntary – can be a source of great suffering. For example, for some time now I’ve been seeing a man whose professional development has forced him to distinguish himself from his group of origin, which is painful for him. The curious thing is that in the West, we could almost be faced with the opposite situation: the inability to achieve individual and professional fulfillment can be unpleasant for certain individuals!

What about psychological care for children in Bamako?

Unfortunately, there are few structures or organizations in Bamako to help children in distress, despite the obvious need, as the situation is already critical for adults (there is only one psychiatric center and a handful of psychologists for the whole country!) Parents and children, for example, quickly find themselves at a loss when anautism diagnosis is made. There’s little information, no network of specialists and little treatment available. For my part, I try to raise their awareness by putting them in touch with other parents in the same situation, as well as with specialists whose approach to the pathology is still different from my own.

To help you better understand your patients, have you made yourself aware of Malian culture?

Indeed, it’s an imperative if we want to get as close as possible to patients’ feelings and experiences. Among other things, my gradual learning of Bambara (Mali’s national language) has made me aware of the way in which ideas and things are expressed. This language is particularly rich in metaphors. It’s interesting to note, for example, that depression is said here as « the weeping heart ». This awareness has enabled me to refine my therapeutic practices in consultation.

Do you meet many Western psychologists in Bamako?

No, and the few I meet are only here for a limited time. There seem to be two or three of us at the moment, but I’m the only French speaker.

Who should a Western psychologist contact if he or she wants to work in the humanitarian field?