Ethnographing mental troubles in Mayotte without access to the psychiatric hospital: the case of Amina

Abstract

Through the case study of Amina, a woman afflicted by disorders interpreted by those around her as being caused by masera spirits, this article analyses the obstacles to access psychiatric care and the mistrust of biomedical institutions in Mayotte. It aims to understand how mental disorders could be better accompagnied by examining the institutional and social process that currently hinder their care. Indeed, as the most recently established French department, Mayotte presents a postcolonial context in which French norms intersect with local social organisation and aetiologies. The study in which the data of this case are included is based on twenty-two months of ethnography conducted between 2017 and 2024, combining participant observation of ritual experts and medical and social professionals, interviews about life stories, and ethnography of the everyday life of young people in affliction. This case study is unusual in that it is based not on direct interviews with Amina, but on observations about her and on the accounts of her family, mainly those of her sister. According to local conceptions of mental disorders, questioning Amina directly about her experiences could aggravate her condition. Amina, whom I met in 2017, was living with her husband and their three children at her mother-in-law's house when she suddenly began to experience physical and psychological disorders as her “ grand mariage ” (manzaraka) approached. This ritual was made to mark the entry of her husband and children at her home in her village, according to uxorilocal principles. These symptoms were attributed to masera spirits sent, according to her sister, by her mother-in-law – who did not want her grandchildren to leave her home – or her husband's ex-wife – jealous of the children Amina had with him. According to a neighbour, they were sent by a jealous neighbour who wanted to take over the land where Amina's house was built. Thus, the ‘social use’ of Amina's individual affliction links her to social tensions surrounding uxorilocal residence, undifferentiated inheritance, recent land pressure and the reproduction of the uterine group (women from the same maternal line, their children and husbands). The uterine group is very important in everyday life in Mayotte: due to uxorilocality, it is the fundamental unit of organisation for care and protection, in which women take care of daily tasks, while men finance rituals. After months of rituals and care, when Amina's behaviour deteriorated, the idea of psychiatric hospitalisation was raised and then abandoned. This refusal stemmed, on the one hand, from the conviction shared by her maternal aunts (members of her uterine group) that biomedical treatment would aggravate an affliction caused by spirits (the masera) and, on the other hand, from her husband's fear that hospitalisation would lead to place their children. This fear reflects the mistrust of the state's social and medical institutions, which are perceived as wielding excessive power over families. It underscores the link between psychiatry and state control, seen as a means of regulating behaviour. This ambivalence has its roots in Mayotte's colonial and postcolonial history, where health institutions introduced since the 1980s imposed norms often at odds with local values, leading to the 2001 Mental Health Centre being seen as representing Foucauldian ‘biopolitical’ power that acts on bodies and behaviours. However, in 2024, several years after I met Amina, she was said by her sister to be ‘cured’ but has lost custody of her children, who have been entrusted to their father and paternal grandmother. The intervention of social services demonstrated how they enforced state authority in a conflict between uterine groups, favouring the paternal line despite the local norms which favour the maternal line in such situations. This article concludes by stating that the main obstacles to psychiatric hospitalisation for people suffering from mental disorders in Mayotte are the failure to take into account three phenomena specific to the overseas department of Mayotte. Firstly, local aetiologies, as these mental disorders are frequently attributed to harmful spirits called masera, but also to the evil eye (matso ya peu) or to objects with harmful agentivity (masairi) made by jealous or envious rivals. These people with mental disorders must therefore be protected from contact with people who are not members of their family, conceived as potential rivals. Secondly, the role of the uterine group in the care and protection of these people from potential ill-intentioned rivals. Finally, the fact that medical and psychological practices are part of the biopolitical control exercised by the State in this former colony, which became a French overseas department in 2011. This article concludes by suggesting ways in which these ethnographic observations and anthropological analyses can be applied to adapt psychiatric practices in Mayotte in a concrete and precise way: take into account local aetiological explanations as cumulative explanations rather than competing with psychiatric explanations, allow the uterine group to be involved in care and encourage participation of their members in decision-making.