Where had this woman come from? What had brought her to this condition?
The police found her on the streets and took her to a hospital that refused to clean her wounds, much less to take her in. So the police brought her to Vita. Before living in a downtown public square, she had had legal residence in the São Paulo Psychiatric Hospital, but she had been released as “cured”—in other words, overmedicated and no longer violent. And before that? No one knew. She had passed through the police, through the hospital, through psychiatric confinement and treatment, through the city’s central spaces—and in the end she was putrefying even before death. It is clear that dying such as hers is constituted in the interaction of state and medical institutions, the public, and the absent family. These institutions and their procedures are symbiotic with Vita: they make death’s job easier. I use the impersonal expression “death’s job” to point out that there is no direct agency or legal responsibility for the dying in Vita.
What happened to this nameless woman was far from an exception—it was part of a pattern. In a corner, hunched over a bed in the women’s room sat Cida, who seemed to be in her early twenties. Diagnosed with AIDS, she had been left at Vita by a social worker from the Conceição Hospital in early 1995. During her early days at Vita, the volunteers began calling her Sida, the Spanish word for AIDS. Later, I was told that they had replaced the “S” in her new name with a “C”—“like in Aparecida, so that people would stop mocking and discriminating against her.” I was surprised to learn that the volunteers believed that Cida and a young man were the only AIDS cases in Vita. Too many of the wasted bodies I saw also had skin lesions and symptoms of tuberculosis. Oscar told me that Cida came from a middle-class family, but that no one ever visited her. She spoke to no one, he said, and sometimes did not eat for three or four days. “We have to leave the food in a bowl in the corridor, and sometimes, when nobody is watching, she comes down from her bed and eats,” explained the volunteer, “like a kitty.”
Here, animal is not a metaphor. As Oscar argued: “Hospitals think that our patients are animals. Doctors see them as indigents and pretend that there is no cure. The other day, we had to rush old Valério to the emergency. They cut him open and left surgical materials in there. The materials became infected, and he died.” What makes these humans into animals not worthy of affection and care is their lack of money, added Luciano, another volunteer: “The hospital’s intervention is to throw the patient away. If they had sentiment, they would do more for them . . . so that there would not be such a waste of souls. Lack of love leaves these people abandoned. If you have money, then you have treatment; if not, you fall into Vita. O Vita da vida [the Vita of life].”
As I see it, Oscar and Luciano were not using the term “human” in the same way human rights discourses do, with a notion of shared corporeality or shared reason. Neither were they opposing it to “animal.” Rather than referring to the animal nature of humans, they spoke of an animal nature of the medical and social practices and of the values that, in their ascendancy over reason and ethics, shape how the abandoned are addressed by supposedly superior human forms. “There was no family; we ourselves buried old Valério. The human being alone is the saddest thing. It is worse than being an animal.” Although they emphasized the “animalization” of the people in Vita, Oscar and Luciano conveyed a latent understanding of the interdependence of the terms “human” and “animal” and of a hierarchy within the human itself. The negotiation over these boundaries, particularly in the medical realm, allows some human/animal forms to be considered inappropriate for living.20
In the face of the First World War, Sigmund Freud wrote an essay entitled “Thoughts for the Times on War and Death.” Freud spoke of a generalized wartime confusion and disillusionment that he also shared and of people being without a glimmer of the future being shaped. “We ourselves are at a loss as to the significance of the impressions which press in upon us, and as to the value of the judgments which we form . . . the world has grown strange to [us]” (1957b:275, 280). This sense of an ethical and political void experienced by “helpless” citizens had been provoked by “the low morality shown by states which pose as the guardians of moral standards” and by the brutality demonstrated by individuals who, “as participants in the highest human civilization, one would not have thought capable of such behavior” (280). At stake, in Freud’s account, was not the citizen’s failure to empathize with the suffering of fellow humans but his or her estrangement from imaginaries gone awry. This anxiety over the discredited imaginaries of the nation-state and of supposedly inexorable human progress stood for people’s actual incapacity to articulate the function of the Other’s death in the organization of reality and thought.
We moderns—this is how I read this melancholic Freud—operate with an instrumental idea of the human and are time and again faced with a void in what constitutes humanness. One’s worthiness to exist, one’s claim to life, and one’s relation to what counts as the reality of the world, all pass through what is considered to be human at any particular time. And this notion is itself subject to intense scientific, medical, and legal dispute as well as political and moral fabrication (Kleinman 1999; Povinelli 2002; Rabinow 2003; Asad 2003). It is in between the loss of an old working idea of humanness and the installment of a new one that the world is experienced as strange and vanishing to many in Vita. I do not refer here to the universal category of the human but rather to the malleability of this concept as it is locally constituted and reconstituted, with semantic boundaries that are very fuzzy. Above all, the concept of the human is used in this local world, and it cannot be artificially determined in advance in order to ground an abstract ethics.21
Vita is the word for a life that is socially dead, a destiny of death that is collective. “These people had a history,” insisted Zé. “If the hospitals kept them, they would be mad; in the streets, they would be beggars or zombies. Society lets them rot because they don’t give anything in return anymore. Here, they are persons.” Zé was right on many counts: disciplinary sites of confinement, including traditionally structured families and institutional psychiatry, are breaking apart; the social domain of the state is ever-shrinking; and society increasingly operates through market dynamics—that is, “you shall be a person there, where the market needs you” (Beck and Ziegler 1997:5; see also Lamont 2000).22 Yes, treating the abandonados as “animals” might release individuals and institutions from the obligation of supplying some sort of responsiveness or care. But I was also intrigued by the paradox voiced by Zé: that these creatures—apparently with no ancestors, no names, no goods of their own—actually acquired personhood in the place of their dying. The idea that personhood, according to Zé, can be equated with having a place to die publicly in abandonment exemplifies the machinery of social death in Brazil today—its workings are not restricted to controlling the poorest of the poor and to keeping them in obscurity. But the idea of “personhood in dying” also challenged me as an ethnographer to investigate the ways people inhabited this condition and struggled to transcend it.
Though no money circulates in Vita’s infirmary—there is nothing to be bought or sold—many inhabitants hold something: a plastic bag, an empty bottle, a piece of sugar cane, an old magazine, a doll, a broken radio, a thread, a blanket. Some nurse a wound or simply count their fingers. One man carries garbage bags with him day in and day out. They are his sole property. He bites people who try to take the trash away. “Sometimes there is food rotting in these bags, even feces,” said Luciano. “Then we give him a tranquilizer, put him to sleep, and replace the things in the bags.” The volunteer added, “Any institution needs control in order to exist,” without explaining where the prescriptions for the tranquilizers came from.
At first, I saw the objects carried by the abandoned as standing for their lack of relationship with the world outside Vita as well as for their past experiences, impossibly distant but remembered. In this sense, the objects are a defense against everything that banishes these people from the field of visibility