issue 209 - July 1990
The madness of hunger
The people of North-East Brazil are starving. But they
put their own physical anguish down to 'nervous problems'.
Nancy Scheper-Hughes explains how drugs and
politics have brought this about.
I was going through the death-registry books in the cartório civil of Bom Jesus da Mata, a market town in the sugar-plantation region of Pernambuco in the Brazilian North-East. I came across the following handwritten entry:
Died: September 18, 1985, Luiza Alves da Conceição, female, brown eyes, aged 33, spinster.
Cause of Death: dehydration, starvation
Observations: The deceased left behind no children and no possessions. She was illiterate. She did not vote.
That was the end of the entry, but I was able to discover that Luiza had died in the municipal hospital of Bom Jesus and was buried in a pauper's coffin in an unmarked grave wrapped only in a hospital sheet.
I think about Luiza Alves from time to time. I imagine, from what I know of life in Bom Jesus, that she probably thought of herself as fraca (physically weak) or fraca de juízo (mentally weak) and prone to ataque de nervos (nervous attacks). She may have cried a good deal without understanding why. Perhaps sometimes she became angry. She may have lashed out, uncontrollably, at a ministering hand during her final agonia at the hospital.
I have seen deaths like these and they are not very pretty. The people of Bom Jesus sometimes refer to them as doença de cão - literally dog's disease. They are referring to rabies, which in Portuguese is called raiva - literally rage, fury, madness. The madness of hunger is indeed very much like rabies and it is truly a dog's death.
References to the delírio, the madness of hunger, can be found as early as the sixteenth century in the writings of Portuguese navigators, and it is still a recurring theme in Brazilian literature now. It is the subjective voice, the primary experience of hunger.
The North-East of Brazil is a land of many hungers, and of a formidable thirst. Infants who die of dehydration, their blackened tongues hanging from their mouths, compete for attention with equally brutal images of thirst-driven sertanejos who walk hundreds of kilometres to escape the drought of the sertão or hinterland.
So we must begin with the context, the 600,000 square miles of suffering that is the pock-marked face of the North-East. Here cloying fields of sugar cane rot amidst hunger and disease; here authoritarian landlords compete for power with anarchistic bandits, and rural labourers are bound to a semi-feudal economy in a state of perpetual anxiety.
The hunger of the coastal sugar-cane workers and their families is constant and chronic. The hunger of the sertanejos is periodic, acute and explosive.
Since 1964, when I first worked (and lived) in the region, I have been seeing starvation: a host of children of one and two years who cannot sit up unaided, who do not or cannot speak, whose skin is stretched so tightly over the chest and stomach that every curve of the breastbone and ribs stands out. The arms, legs and buttocks of these children are often stripped of flesh so that the skin hangs in folds. The buttocks are often discoloured. The bones of the face are fragile, the eyes prominent, the hair thin and wispy. The eyelashes can be extraordinarily long. Some children take on an unnatural, waxen appearance that their mothers sometimes see as a kind of death mask.
No other calamity has quite the shattering effects on personality and behaviour as the experience of acute hunger. The most obvious effect is a frenzied rage alternating with periods of euphoria, excitement and irritability, often subsiding into passive withdrawal and indifference.
At first in Bom Jesus one's ear is jarred by the way hunger and nervousness are interchangeable in the language of the poor residents of the hillside slum called Alto do Cruzeiro (Crucifix Hill). A mother will stop you on her way up the hill to say that things aren't good, that her children are nervous because they are hungry. Another woman returning from feira (market) tells you that she became dizzy, confused and 'nervous' at the price of meat. Dona Teresa tells you that her husband Manoel came home from work sick. his knees shaking, his body weak and so tired he could barely swallow a few mouthfuls of dinner. He is suffering from a crise de nervos, as is usual towards the end of the week, when everyone is anxious because there's nothing to eat.
I am sitting on the doorstep with several women of the Alto discussing nervos with them. Anger, discontent, anxiety, hunger and even parasitic infections (all related to their work as laundrywomen, rural labourers and domestic workers) are filtered through the metaphor of nervos.
Sebastiana: As for me, I'm always sick, I'm fraca de nervos (I have weak nerves).
Me: What are your symptoms?
Sebastiana: Trembling, a great chill in my bones. Sometimes I shake until I fall.
Maria Teresa: There are many kinds of nervos.
Me: What's 'anger nerves' about?
Rosa: That's if your patroa says something to you that really ticks you off, but because she's your boss you just go away without saying anything. But inside you're so angry you could kill her, you really wish she were dead. The next day you're likely to have 'anger nerves'.
Me: What about 'fear nerves'?
Maria Teresa: When her mother died, Black Irene gave out such a blood-curdling scream in the middle of the night that we all woke up with a jump. My son went running to Irene's house to see what was the matter. When he returned he fell down on the floor clutching his heart in an agonia of pain and trembling. Ever since that night he suffers from nervos.
Sebastiana: I only suffer from overwork nervos. I've washed clothes all my life, for almost 60 years; and now my body is as worn out as Dona Carmen's sheets. [This is a slur against a notorious wealthy miser who is too mean to buy new sheets]. When I come home from the river with that heavy basin of wet laundry on my head, my knees begin to shake, and sometimes I lose my balance and fall right on my face. What humiliation!
Me: Is there a 'cure' for overwork nerves?
Sebastiana: I take tonics and Vitamin A.
Rosa: Yes, lots of people take tonics, others take nerve pills, a lot take tranquillizers.
Maria Teresa: Don't forget sleeping pills.
Sebastiana: At night when everything is still, and the night is so dark, so strange, time passes slowly. The night is long. I almost go mad with nervos at times like that. I think of so many things, so many sad and bitter thoughts cross my mind. Memories of my childhood and how hard I was made to work, working like that in the fields on an empty stomach. Then the tremors begin, and I have to get out of bed. It's no use, I won't sleep any more that night. My illness is really just my life.
What I wish to propose is that for this poor and hungry population many of the physiological symptoms of which they complain are also symptoms of chronic hunger. And during the past two decades of my involvement with these people I have seen a discourse on nervos and sickness replace a discourse on angry hunger.
I am not arguing that nervos can be reduced to hunger alone, or that nervos is an exclusively poor or working-class phenomenon. The 'beauty' of nervos as a folk illness syndrome is its flexibility. It is an all-purpose complaint, one that can be invoked by a frustrated middle class to express its dashed expectations in the wake of Brazil's decanonized 'Economic Miracle', by the urban working class to express their condition of powerlessness, and by an impoverished class of sugar-cane cutters and their families to express their hunger.
The question is, how did these people come to see themselves primarily as nervous and only secondarily as hungry, malnourished? How is it that mortally tired cane cutters come to define themselves as 'weak' rather than overworked and exploited? Worse, when resentment over exploitation is recognized, how did it ever get reinterpreted as illness? And, finally, how can it be that chronically hungry people will 'eat' medicines while going without their staple foods?
Nervos is a social illness. It allows hungry, irritable and angry Nordestinos, just now emerging from more than 20 years of militarism and political repression, a safe way to express their discontent. If it is dangerous to engage in political protest (and it is) and, as one of my informants Biu complained, if it is pointless to reclamar, to argue with God (and it would seem to be so), hungry and frustrated people can transform hunger into 'breakdown' and 'mental' problems. When people do so, the health-care system and the political machinery of the community are fully prepared to back them up in their unhappy and anything-but-free choice of symptoms.
Because the people of Alto do Cruzeiro truly suffer from headaches, tremors, weakness, tiredness, irritability, angry weeping and other symptoms of what people call nervos, they look to the doctors, pharmacists and political bosses and patrons from Bom Jesus for a 'cure to the 'sickness'. They line up in clinics, in drug stores, in the municipal dispensary and they want powerful medicines to make them 'strong' and 'lively' (full of animacao - a kind of vitality and readiness for pleasure and enjoyment in the body and its senses that is so Brazilian). They do not leave without these magical, potent prescription drugs: vitaminas, fortificantes, sôro, but also antibiotics, painkillers and sleeping pills. And they get them, if they're lucky, even without paying for them.
Why medicine? If it is power that the leading families who supply them want, why not simply distribute food to hungry people? Medicalization mystifies. It isolates the experience of misery and it domesticates people's anger. There is power and domination to be extracted from the defining of a population as 'sick' or 'nervous'. To acknowledge hunger (which is not a disease but a social illness) would be tantamount to political suicide among leaders whose power comes from the same plantation economy that produced that hunger in the first place.
This 'bad faith' operates among the doctors and pharmacists who allow their knowledge and skill to be abused; among the politicians who wish to see themselves as community benefactors, while knowing full well that they are nothing of the sort; and even among the poor who are so often critical of the medical 'care' they receive yet continue to hold out for a medical solution to their economic problems.
The determination to see malnutrition and dehydration as something other than what they are, as a nervous condition to be treated with painkillers, tranquillizers, tonics and elixirs, represents the worst instance of collective bad faith in Bom Jesus de Mata. This, too, is the madness of hunger.
Nancy Scheper-Hughes is Professor of Anthropology at the University of California, Berkeley. She is the author of many books, including Death Without Weeping: The Madness of Hunger in North-East Brazil, which will be published next year by the University of California Press.