Matt Black via TIME

Martin Kaloshi

Co-Managing Editor

“The kids are all sick; rain passes through the plastic. Who has health? Health nobody has…. Every day we are ill, all kinds of illnesses, it is never good. There is no medical aid. Only if one has money for the bus and gets in line early in the morning and waits till late at night. But then one loses the day of work. To waste time, that is all there is.”

These words are José Duarte’s, taken from anthropologist João Biehl’s Vita: Life in a Zone of Social Abandonment. To make space for a new tourist centre, the government kicked José, his wife, and their four children out of the city’s historic district. They live on the outskirts of Salvador, Brazil, in a hut made of plastic bags. While they are covered by Brazil’s universal healthcare system on paper, José explains that at the medical office, he is only made to sign forms that never get back to him. He and his neighbours are stressed sick by the lack of housing and jobs, safety concerns, and growing police violence in their area. They feel the government has failed them, and that they’ve failed  their children.

José’s destiny is not an isolated case. Zones of social abandonment, as Biehl describes them, exist all over Brazil. One of them, a complex named Vita in the southern city of Porto Alegre, would become the setting for Biehl’s ethnography of the same name.

Vita is where the homeless, mentally ill, and dying await death. Started by ex-drug dealer Zé das Drogas in the ‘80s as a makeshift rehabilitation centre, it soon became populated by society’s sick and unwanted, who were dumped there by hospitals, police, and family. The complex is crowded and dirty, with the sickest individuals separated from the recovering ones only by a gate and some volunteers. In Biehl’s words, Vita is a place of “waiting for [nothing].”

There, Biehl meets Catarina: a kind-mannered young woman who is considered by everyone around her to be “crazy.” We get to know Catarina intimately through her accounts to Biehl, as well as the dictionary of seemingly random words she’s compiling. In just over 300 pages, we are made aware of the institutions — medical, state, and familial — that mediated Catarina’s eventual social abandonment.

Catarina was first hospitalized for mental illness by a family friend in 1988, during a time where patients could deny hospitalization for all reasons but psychiatric (these patients were seen as threats to self and family, who could consequently dump relatives they considered too difficult to handle.) There, she was immediately diagnosed as schizophrenic.

At this time, Catarina was a housewife, married to her husband since the age of eighteen and living with his family. She details her home life:

“When my thoughts agreed with my husband and his family, everything was fine….But when I disagreed with them, I was mad. It’s like a side of me had to be forgotten. The side of wisdom.”

Her husband then had no trouble getting rid of her. With psychiatry validating his account of her behaviour, her voice was effectively silenced.

This all occurred during Brazil’s large-scale push for deinstitutionalization, where public health officials and physicians were becoming increasingly aware of the need to “debiologize pathology and socialize suffering.” The idea was to move mental health care away from long-term psychiatric institutions and toward more community-based settings in the aim of offering better care.

In practice, however, Catarina was put under a slew of pharmaceuticals, successfully tagged as “mad.” In and out of various hospitals around the country for decades, she finally ended up at Vita.

Throughout this time, she would often complain of pain in her legs. Her husband’s family noted that she had been “dragging her legs” even when she was still at home. When we meet Catarina through Biehl in the early 2000s, she is already wheelchair-bound.

“Now I can no longer leave. I must wait for some time. I consulted a private doctor, two or three times. When it is needed, they also give us medication here. So one is always dependent. One becomes dependent.”

When she told doctors about her “rheumatism,” her pain was dismissed as merely a side effect of her delusions.

“Only because I cannot walk I have to stay in the stone age

here in Porto Alegre

Our voice makes contact with the infirmity and becomes imperceptible.”

          —Taken from Catarina’s dictionary

With the help of Biehl and the doctors he goes to see on Catarina’s behalf, Catarina’s symptoms were finally understood as Machado-Joseph disease, a neurodegenerative disorder causing a gradual loss of muscle control. While she was able to receive better medical attention, her physical decline was already irreversible. Catarina lived out the rest of her life at Vita, where she died in 2003.

How many Catarinas are there in the world?

If I had to guess, it would be in the millions. Tens of millions, maybe. In the wake of COVID-19 in Montreal, we saw Vita unfolding in our own long-term care homes. Résidence Herron, a Dorval senior home founded in 1988 (just one year after Vita), made headlines in April 2020 after seeing 47 residents die following mass staff desertion. According to various health professionals who entered, conditions were “concentration camp-like.” Residents were discovered dehydrated, malnourished, and lying in soiled beds or overflowing diapers.

Joyce Echequan, an Atikamekw mother who died at the hands of Quebec’s healthcare providers during the pandemic, is a tragedy that will also stay in my mind. In a Facebook Live video she recorded in the hospital before her death, she’s seen crying out in agony as healthcare workers make racist remarks and call her “stupid as hell,” neglecting her severe heart complications for drug withdrawal.

Catarina, José, the seniors at Herron, and Joyce exist all over the world — sometimes passively, sometimes actively abandoned by the complex web of medicine, state, economy, and family that has failed to protect them. Their stories remind us that health is inseparable from a patient’s economic reality, their environment, and the institutions that govern their life.

Vita dissects the networks that caused Catarina, then forces us to recognize a deeply painful truth: there are Catarinas everywhere.