Ricardo, Quichi, Chris
Joao Biehl is Professor of the Department of Anthropology at Princeton University, working in the fields of Sociocultural and Medical Anthropology, Public Health and Science and Technology Studies. He is Co-Director of Princeton’s Program in Global Health Policy. His recent work includes Vita: Life in a Zone of Social Abandonment (2005) and Will To Live: AIDS Therapies and the Politics of Survival (2009), innovative ethnographic studies into the limits of the human condition through the experience and management of mental illness and AIDS, respectively. Both works were done in collaboration with photographer Torben Eskerod.
Initially, Biehl had written his PhD dissertation on the control of AIDS in Brazil, which in 1996 became the first developing country to institute a social policy of universal access to AIDS therapies, specifically through massive distribution of antiretroviral drugs (ARVs). During this time, he encountered the emergence of centers where the homeless, the sick, unproductive and mentally ill of the urban poor where left to die. These cites, which he calls “zones of social abandonment” were proliferating throughout the mayor urban centers of Brazil through the complex articulation of public health policies, medical institutions and pharmaceuticals economies in relation to neoliberal regimes of citizenship.
Zones of Social Abandonment
Vita, an asylum in the city of Porto Alegre, Capital of the state of Rio Grande do Sul, constitutes a “dump site” of the human bodies of those unwanted and unproductive members of society. The ethnography is centered in a woman resident, Catarina, who suffers from chronic pains, which she associates with hereditary rheumatism, against the indifference and incompetence of a plethora of health professionals who have had contact with her during her long clinic history.
As with the other anonymous inhabitants of these zones of abandonment, little is known about Catarina’s identity or subject position within the family and larger social context besides the diagnosis – or rather her stigma – of “madness” that came to replace her identity and personhood. Catarina resisted the exclusion and abandonment instrumentally forged through a history of interactions with mental institutions and the progressive rejection of her family nucleus. Faced with a human condition in which “voice can no longer become action” (p. 11) Catarina refused to be reduced to her physical condition and to accept social exclusion. She uses writing as a way to remember and think about the complex events of her life and the forces that shaped these events carrying her to her present state.
Crudely pointing to a routine of silence, oblivion, physical and symbolic violence, her “dictionary” as an act of writing, Biehl reveals, constitutes a powerful vehicle for mediating agency and desire, and for resisting the power of pharmaceutical control and the closure of identity imposed by family, diagnosis and other contextual determinations.
The fragmentary writings of Catarina stimulated Biehl to take a dialogical approach to ethnography, founded on an ethics of listening that enables him to find “pieces of truth” about Catarina’s physiological deterioration, her expulsion from social and family life, and about her resistance to being determined by these forces. First, he found structural similarities that linked the different stories of exclusion and abandonment that he discovered in Vita, stories that nevertheless remained invisible and disjointed to the actors that interacted with them on a daily basis. Second, overcoming the rejection to the fragmented mode of enunciation of patients medicated with psycho-pharmaceuticals, usually thought of as nonsensical, Biehl started to read in the writings not only the concrete effect of family and institutional exclusion, but also the resistance of a subject to be reduced to a meaningless unproductive entity with no ties to the world. The dictionary represents ultimately the struggle for an alternative symbolic order and an instrument of thought, agency and self -affirmation.
“Marked off as mad and left to dead, yet claiming understanding and desire”, Catarina, the author argues, gives meaning in her dictionary to “the circuits in which her experience took form and suggests that life is potentially inexhaustible” (p. 118). He uses Catarina’s writing to guide and focalize his analysis and thinks about her subjectivity as a “complex symbolic, social, and medical artifact in the making that illuminates the conditions of life, thought, and ethics in contemporary Brazil” (p. 118).
Within this analytical set up, Biehl proposes to focus on three related problems that Catarina’ subjectivity seemed to reveal:
1) How inner worlds are remade under economic pressures, a central aspect of subjectivity intimately linked to family relationships within specific political economic regimes and modes of production.
2) The domestic roles of pharmaceuticals as moral technologies, considering that psycho-pharmaceuticals played an important role in altering Catherina’s sense of being and her value for others (p.9).
3) The common sense that creates a category of unsound and unproductive individuals who are left to die, after being considered not worth of affection or care. Biehl proposes this as a fundamental problem of anthropology, which must assess those “judgments of reality [that] determine which kinds of lives societies support” (p.9). The question here is what is means to be human in a structural arrangement in which the possibility of agency, voice and action is foreclosed. He articulates the notion of the animalization to illustrate the result of the “machinery” of the zones of social abandonment.
The author assesses these problems by revising the medical archives of Catarina and listening to the discourses that mediate and explain the actions of health professionals, bureaucrats and activists, with respect to the mentally ill, revealing at the same time how neoliberal governance is reshaping public health policies. Furthermore, he approaches Catarina´s family to try to understand how structural changes in health institutions mediated by pharmaceutical trends of management and social control, restructure and define the systems of kinship and affect within the family. The multiple narratives he encounters reveal the social construction of Catarina´s madness and ultimately the social function that zones of abandonment play in getting rid of unproductive members of society by denying their citizenship. In the face of increasing economic and biomedical inequality and the breakdown of the family, “human beings are routinely separated from the normal political status and abandoned to the most extreme misfortune: death in life” (p. 38). Biehl demonstrates that “through the production of social death, both state and family are being altered and their relations reconfigured” (p. 21). Specifically, in the domain of health, the constant reconfiguration of economical, social and scientific rationalities determine and model new experiences of illness, subjectivity and social control.