strings of words that compose her dictionary, the book’s touchstone. The selection presented in Part Six is just a small sample of the richness of her creation. The more I learned of the literal conditions of Catarina’s life, the more I seemed able to decipher some of the raw poems in her writing. I hope that this ethnographic rendering of Catarina and her life will also help the reader to hear the desperation lying within her words and to respond to her unique capacity to transfigure that desperation into a form of art.
As the ethnographer and interpreter, I am always present in the account. Every time I went one step further in knowing Vita and Catarina and their symbiotic world, I was faced with anthropology’s unique power to work through juxtaposed fields and particular conditions in which lives are—concurrently, as it were—shaped and foreclosed. I find this ethnographic alternative to be a powerful resource for building social theory. The book weaves various theoretical debates through the human and ethnographic material. Throughout the book, as layers of subjectivity, reality, and theory open up, the figure and thought of Catarina provide critical access to the value systems and often invisible machineries of making lives and allowing death that are indeed at work both in the state and in the home. The book thus also represents the anthropologist’s ethical journey: identifying some of the ordinary, violent, and inescapable limits of human inclusion and exclusion and learning to think with the inarticulate theories held by people like Catarina concerning both their condition and their hope.
Vita is a progressive unraveling of the knotted reality that was Catarina’s condition—misdiagnosis, excessive medication, complicity among health professionals and family members in creating her status as a psychotic—and the discovery of the cause of her illness, which turned out to be a genetic and not a psychiatric condition. It charts the domestic events and institutional circumstances through which she was rendered mentally defective and hence socially unproductive and through which her extended family, her neighbors, and medical professionals came to see the act of abandonment as unproblematic and acceptable. Psychopharmaceuticals used to “treat” Catarina mediated the cost-effective decision to abandon her in Vita and created moral distance. Zones of abandonment such as Vita accelerate the death of the unwanted. In this bureaucratically and relationally sanctioned register of social death, the human, the mental, and the chemical are complicit: their entanglement expresses a common sense that authorizes the lives of some while disallowing the lives of others.
Catarina embodies a condition that is more than her own.15 Her life force was unique, but the human and institutional intensities that shaped her destiny were familiar to many others in Vita. In the dictionary, Catarina often referred to elements of a political economy that breaks the country and the person down and to herself as being out of time:
Dollars
Real
Brazil is bankrupted
I am not to be blame
Without a future
By tracking the social contexts and exchanges in which Catarina’s abandonment and pathology took form, this book reflects on the political and cultural grounds of a state that keeps playing its part in the generation of human misery and a society that forces increasingly larger groups of people considered valueless into such zones, where it is virtually guaranteed that they will not improve. The book demonstrates that, through the production of social death, both state and family are being altered and their relations reconfigured. State and family are woven into the same social fabric of kinship, reproduction, and death. Catarina’s body and language were overwhelmed by the force of these processes, her personhood unmade and remade: “Nobody wants me to be somebody in life.”
In many ways, Catarina was caught in a period of political and cultural transition. From his inauguration in 1995, President Fernando Henrique Cardoso worked toward state reform that would make Brazil viable in an inescapable economic globalization and that would allow alternative partnerships with civil society to maximize the public interest within the state (Cardoso 1998, 1999).16 But in the process and on the ground, how are people, particularly the urban poor, struggling to survive and even prosper? And what is happening to the polity and social relations?
Scholars of contemporary Brazil argue that the dramatic rise in urban violence and the partial privatization of health care and police security have deepened divisions between the “market-able” and the socially excluded (Caldeira 2000, 2002; Escorel 1999; Fonseca 2000, 2002; Goldstein 2003; Hecht 1998; Ribeiro 2000). All the while, newly mobilized patient groups continue to demand that the state fulfill its biopolitical obligations (Biehl 2004; Galvão 2000). As economic indebtedness, ever present in the hinterland, transforms communities and revives paternalistic politics (Raffles 2002), for larger segments of the population, citizenship is increasingly articulated in the sphere of consumer culture (O’Dougherty 2002; Edmonds 2002). An actual redistribution of resources, power, and responsibility is taking place locally in light of these large-scale changes (Almeida-Filho 1998). Overburdened families and individuals are suffused with the materials, patterns, and paradoxes of these processes, which they are, by and large, left to negotiate alone.
The family, as this ethnography illustrates, is increasingly the medical agent of the state, providing and at times triaging care, and medication has become a key instrument for such deliberate action.17 Free drug distribution is a central component of Brazil’s search for an economic and efficient universal health care system (a democratic gain of the late 1980s). Increasing calls for the decentralization of services and the individualization of treatment, exemplified by the mental health movement, coincide with dramatic cuts in funding for health care infrastructure and with the proliferation of pharmaceutical treatments. In engaging with these new regimes of public health and in allocating their own overstretched and meager resources, families learn to act as proxy psychiatrists. Illness becomes the ground on which experimentation and breaks in intimate household relations can occur. Families can dispose of their unwanted and unproductive members, sometimes without sanction, on the basis of individuals’ noncompliance with their treatment protocols. Psychopharmaceuticals are central to the story of how personal lives are recast in this particular moment of socioeconomic transformation and of how people create life chances vis-à-vis what is bureaucratically and medically available to them.18 Such possibilities and the fore-closures of certain forms of human life run parallel with gender discrimination, market exploitation, and a managerial-style state that is increasingly distant from the people it governs.
I need to change my blood with a tonic
Medication from the pharmacy costs money
To live is expensive
The fabric of this domestic activity of valuing and deciding which life is worth living remains largely unreflected upon, not only in everyday life, as Oscar, the infirmary coordinator, mentioned, but also in the literature on transforming economies, states, and civil societies in the contexts of democratization and social inequality. As this study unfolded, I was challenged to devise ways to approach this unconsidered infrastructure of decision-making, which operates, in Catarina’s own words, “out of justice”—that is, outside the bounds of justice—and which is close to home. Fieldwork reassembled the decision-making process at various points and in various public interactions.
This ethnography makes visible the intermingling of colloquial practices and relations, institutional histories, and discursive structures that—in categories of madness, pharmaceuticals, migrant households, and disintegrating services—have bounded normalcy and displaced Catarina onto the register of social death, where her condition appears to have been “self-generated.” Throughout this chain of events, she knows that the verb “to kill” is being conjugated; and, in relation to her, the anthropologist charts and reflects on what
