The photographs Torben Eskerod took during our first visit to Vita in 1995 and on a later visit in December 2001 give us a sense of the persons who were facing this kind of abjection.23 “Photographs are a means of making ‘real’ (or ‘more real’) matters that the privileged and the merely safe might prefer to ignore,” writes Susan Sontag (2003:7). It would be too much to say that Eskerod’s photographs make real the abandonment in Vita. They are at most an initial approximation, a sincere attempt to render visible this tragic experience. They are his personal testimony to the abandonment in their bodies and to a wakefulness that accompanies social death.
If these photos are shocking, it is because the photographer wants to focus on our learned indifference and provoke some ethical response. If they are haunting, it is because this is an enduring reality, not so far from us. We manage not to see the abandoned in our homes and neighborhoods, rich and poor. How are our self-perceptions and our priorities for action dependent on this blindness?
Arthur and Joan Kleinman argue that the globalization of images of suffering commodify, thin out, and distort experience. This process corroborates our epoch’s dominating sense that “complex problems can be neither understood nor fixed,” fostering further “moral fatigue, exhaustion of empathy, and political despair” (1997:2, 9; see also Boltanski 1999). The key verbs here are “to understand” and “to hope”—so that people’s destinies might be different. For the Kleinmans, the challenge is to ethnographically chart how large-scale forces relate to local history and biography, and thereby to restore context and meaning to the lived experience of suffering captured by the artist.
How to bring into view the reality that ruins the person?
Signaling a shift from the artistic to the political function of artwork, Walter Benjamin (1979) suggested that captioning would become the most important part of photography, the foundation of meaning.24 For some time after our first visit to Vita, I thought that these photos were enough, that they did the work of bringing this reality out of concealment and into the public eye. The photos stayed with me and fueled a desire to return to Vita—not to find a caption but to try to further engage some of the abandoned, to listen to and record what they thought of their plight, who they once had been. By hearing them and tracing their trajectories, I hoped to prevent them from remaining merely depictions of powerlessness and to address the routine domestic and public interactions that foreclosed the possibilities of their lives. Ethnography helps to disentangle these knots of complexity, bringing into view the concrete conditions and spaces through which human existences become intractable realities. And yet, as I began to know these people better, I was challenged to think of life in Vita also in terms of anticipation and possibility.
Before we went back to Vita in December 2001 to conclude the photographic work, I briefed Torben on what my research had found in Vita and beyond. Learning about Catarina’s life history and having clues to the lives of some of the other abandoned affected his approach to the photography. In his earlier pictures of life in Vita, he mostly photographed fragments of people’s bodies, conveying their death-in-life and overall detachment from a larger social body. This time, with some of their fragmented histories in mind, Torben pictured the abandoned at a certain distance, I would say. Enclosure, adjacency to others, and introspection are shown. Older than their bodies tell and yet with time left, the people of Vita appear more familiar to us than before, left with their own intimacy and a way to fold into themselves and reflect.
Infirmary, Vita 2001
Pedro, Vita 1995
Brazil
Consider the old man whose eyes were cast downward, his hands shaking, his body skeletal. Family members had left him at Vita’s gate. I asked him his name even though the volunteers told me that he did not know it. He muttered, “Pedro,” and smiled. He also knew where he had once lived: “Charqueadas.” He then grabbed his throat. “Grrrahaaa . . . hhhrhrraaahhgrrrrss . . . ahhrgaaahgrqqaa . . .” I could not understand. It was not the absence of words but the speaking of nonwords.
Oscar and other volunteers told me that Pedro probably had throat cancer, although they did not know for sure. When they brought him to a nearby hospital, the doctors would not see him—a document was missing—and told him to return in three months. The clinic will not refuse to see him, but it will put him in line, make him return to schedule appointments, and when the doctors finally have time for Pedro, it will probably be too late. Then the clinic can claim, as it does with too many others, that nothing can be done.
The residents of Vita are not simply isolated individuals who, on their own, lost the symbolic supports for their existence. Rather, the abandonados are the carriers and witnesses of the ways in which the social destinies of the poorest and the sickest are ordered. The experience of individuals who live in such a dead space/language is traversed by the country’s structural readjustment, unemployment, malfunctioning public health system, and infamously unequal distribution of wealth.25
Historically, Brazil’s welfare system has been structured so that state intervention varies according to the segment of the population claiming social protection. “Citizenship” has been deemed universal for the minority who are rich, regulated according to market forces for the working class and the middle class, and denied to the multitudes who are poor and marginalized. According to Sônia Fleury, the “noncitizens” might be entitled to some minimum form of social assistance and charity in exchange for their votes—this is their “inverted citizenship” (quoted in Escorel 1993:35). Those occupying the upper strata of society not only live longer; their right to do so is ensured through bureaucratic and market mechanisms.
As I talked to city administrators, public health officers, and human rights activists, I was able to identify some of the institutional networks through which Vita emerged and was integrated into local forms of governance as well as some of the everyday practices that help to constitute the residents’ nonexistence. With the adoption of Brazil’s democratic constitution in 1988, health care had become a public right. “Health is a right of every individual and a duty of the state, guaranteed by social and economic policies that seek to reduce the risk of disease and other injuries, and by universal and equal access to services designed to promote, protect, and recover health,” stated the new Brazilian constitution (Constitution of the Federative Republic of Brazil 1988). The principles of universality, equity, and integrality within health services (Fleury 1997) were supposed to guide the new Brazilian health care system (Sistema ⁄nico de Saúde, or SUS). In practice, however, efforts to implement these principles collided with historically entrenched forms of medical authoritarianism (Scheper-Hughes 1992) and the realities of fiscal austerity, decentralization, and community- and family-centered approaches to primary care, amid the rapid encroachment of private health care plans. In 1989, for example, the federal government spent eighty-three dollars per person on health care, but in 1993 this amount plunged to only thirty-seven dollars (Jornal NH 1994b).
Many of the country’s discourses and practices of citizenship in the 1990s were related to guaranteeing the universal right to health care as the economy and the state underwent a major restructuring.26 The activism of mental health workers was exemplary (Tenorio 2002). They actively engaged in making laws that shaped the progressive closure of psychiatric institutions and their replacement by local networks of community- and family-based psychosocial care (Amarante 1996; Goldberg 1994; Moraes 2000).27 This deinstitutionalization of the mentally ill was pioneered in the state of Rio Grande do Sul (Porto Alegre is its capital), where it was well under way by the early 1990s. In reality, however, the demands and strategies of the mental health movement became entangled