This research is an inquiry into the trajectories and lived experiences of people with mental illness and those taking care of them (family and different kinds of healers) in and around Ouagadougou, Burkina Faso. The situation of ‘the mad’ in West Africa is often presented in images of insecurity and suffering. Reports of the World Health Organisation (2001), Human Rights Watch (2012, 2017), websites of local organisations and other media show pictures of people in chains or on the streets, abandoned by their family. International organisations blame the “global mental health gap” and call for increasing access to psychiatric care. The notion of “gap”, however, seems to ignore the importance of other than biomedical structures available to people who fall mentally ill (or mad). Often under the guidance of family members, they resort to non-biomedical (‘traditional’/’spiritual’) healers without, or before and/or after encountering psychiatric care. Which technologies, structures and meanings surface in the accounts of people with mental illness and their families in Burkina Faso and how and why do they move between them? How do meanings given to madness (or ‘mental illness’) steer, and possibly change, during their trajectories? Why do people with mental illness end up in precarious locations – sometimes in chains or on the streets? What are their (in-)securities? And what kind of lives are they hoping for?