What do you think?
Rate this book
卡塔莉娜: 關於生命療養院, 以及人們如何被遺棄的故事
Vita，拉丁文中「生命」的意思。巴西的阿雷格里港市有一間療養院，名字叫作「vita」。
「生命療養院」創立於1987年，一開始是一間收容毒癮跟酒癮患者的康復中心，然而沒過多久就擴大了守備範圍，有愈來愈多被家人斷絕關係的人──包括精神病患、殘疾者、失業和無家者──被親戚、鄰居、醫院和警方直接「丟」到這裡。任何一個大城市的角落，可能都有一間像這樣的「生命療養院」。被丟進這裡的人無人聞問，沒有人權，也沒有人需要為他們的處境負責。他們本人往往也不清楚、或記得，自己怎麼會來到這個地方。
卡塔莉娜就是其中之一。她是生命療養院的院民，但她跟其他院民有點不同，她總是寫個不停。她說她在寫自己的「字典」，她想把自己的故事記下來。
人類學家畢尤長期研究全球公衛議題，尤其關注社會邊緣人及窮人如何在既有的社會結構及醫療體制中得以存活。1995年3月，他進入生命療養院，開始和裡面的人，包括院民、志工、統籌者一起工作，他想找出城市裡這些許許多多的「Vita」是如何產生，以及那些發生在「卡塔莉娜」們身上的故事。
《卡塔莉娜》有兩條主軸，畢尤一方面探求「生命療養院」這類機構在90年代形成的原因，並將其納入拉丁美洲新自由主義、當代家庭關係崩解、精神病院去機構化、症狀及用藥爭議等脈絡，試圖從公衛及國家框架，為身處其中的每一位患者，還有患者家人、醫護人員、志工們，搭建一個合理且能容身的舞台。
另一條主軸則是撰寫卡塔莉娜的生命史。畢尤透過一場又一場的訪談、追查各式機構的醫療紀錄，拼湊出卡塔莉娜的故事。她的家人為何丟下她？她被丟下的原因，到底是心理上的病、還是身體上的？而在重構卡塔莉娜身世之際，畢尤慢慢看懂了卡塔莉娜的「字典」，懂了她是如何被一個社會所殺，終致邁向真正死亡。
畢尤在序章提了一個很哲學，也很人類學的問題：什麼才是真實？
人類學者田野時念茲在茲的「在地觀點」，在生命療養院得到了最大挑戰：你該如何相信，甚至理解一群可能的瘋子說的話？
自始至終，他們的人生訴說的是一個規模更大的故事，也就是像生命療養院這樣的地方，是如何在貧窮家庭及城市生活中扮演了不可或缺的角色；以及社會認同的過程是如何建構了一個人，或讓一個人死去。
「她向我們介紹了一個跟我們不一樣的世界，但仍能觸及痛處；而透過這個世界，我們有機會讀到她和我們面臨的不同社會性生活及人的境況。透過接觸她的人生及書寫，我們也是在處理自己的問題。『我寫是為了讓自己理解，但，當然，如果你們都理解了，我會非常滿足。』」
「生命療養院」創立於1987年，一開始是一間收容毒癮跟酒癮患者的康復中心，然而沒過多久就擴大了守備範圍，有愈來愈多被家人斷絕關係的人──包括精神病患、殘疾者、失業和無家者──被親戚、鄰居、醫院和警方直接「丟」到這裡。任何一個大城市的角落，可能都有一間像這樣的「生命療養院」。被丟進這裡的人無人聞問，沒有人權，也沒有人需要為他們的處境負責。他們本人往往也不清楚、或記得，自己怎麼會來到這個地方。
卡塔莉娜就是其中之一。她是生命療養院的院民，但她跟其他院民有點不同，她總是寫個不停。她說她在寫自己的「字典」，她想把自己的故事記下來。
人類學家畢尤長期研究全球公衛議題，尤其關注社會邊緣人及窮人如何在既有的社會結構及醫療體制中得以存活。1995年3月，他進入生命療養院，開始和裡面的人，包括院民、志工、統籌者一起工作，他想找出城市裡這些許許多多的「Vita」是如何產生，以及那些發生在「卡塔莉娜」們身上的故事。
《卡塔莉娜》有兩條主軸，畢尤一方面探求「生命療養院」這類機構在90年代形成的原因，並將其納入拉丁美洲新自由主義、當代家庭關係崩解、精神病院去機構化、症狀及用藥爭議等脈絡，試圖從公衛及國家框架，為身處其中的每一位患者，還有患者家人、醫護人員、志工們，搭建一個合理且能容身的舞台。
另一條主軸則是撰寫卡塔莉娜的生命史。畢尤透過一場又一場的訪談、追查各式機構的醫療紀錄，拼湊出卡塔莉娜的故事。她的家人為何丟下她？她被丟下的原因，到底是心理上的病、還是身體上的？而在重構卡塔莉娜身世之際，畢尤慢慢看懂了卡塔莉娜的「字典」，懂了她是如何被一個社會所殺，終致邁向真正死亡。
畢尤在序章提了一個很哲學，也很人類學的問題：什麼才是真實？
人類學者田野時念茲在茲的「在地觀點」，在生命療養院得到了最大挑戰：你該如何相信，甚至理解一群可能的瘋子說的話？
自始至終，他們的人生訴說的是一個規模更大的故事，也就是像生命療養院這樣的地方，是如何在貧窮家庭及城市生活中扮演了不可或缺的角色；以及社會認同的過程是如何建構了一個人，或讓一個人死去。
「她向我們介紹了一個跟我們不一樣的世界，但仍能觸及痛處；而透過這個世界，我們有機會讀到她和我們面臨的不同社會性生活及人的境況。透過接觸她的人生及書寫，我們也是在處理自己的問題。『我寫是為了讓自己理解，但，當然，如果你們都理解了，我會非常滿足。』」
576 pages
First published January 1, 2005
55 people are currently reading
1075 people want to read
About the author
João Biehl
11 books9 followersJoão Guilherme Biehl is Professor of Anthropology at Princeton University
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 30 of 39 reviews
March 24, 2025
“Vita is a dump site of human beings. You must go there. You will see what people do to people, what it means to be human these days. Vita is the end-station on the road to poverty.”
“How does one become another person today? What is the price one pays? How does this change in personal life become part of memory, individual and collective?”
“Psycho-pharmaceuticals 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.”
“Economic globalization, state and medical reform, and the acceleration of claims to human rights and citizenship coincide with and impinge on a local production of social death.”
“Each one was alone; most were silent. There was a stillness, a kind of linquishment that comes with waiting, waiting for the nothingness, a nothingness that is stronger than death. Here, I thought, the only possible distraction is to close one's eyes. But even this does not create a distance, one is invaded by the ceaseless smell of dying matter for which there is language. Like the woman the size of a child, completely curled up in a cradle and blind. Once she began to age and could no longer work for the family, the relatives hid her in a dark basement for years, barely keeping her alive. “Now she is my baby,” said Angela, a former drug user, who most likely has AIDS. She had long ago lost custody of her two children and now spent her days caring for the old women. “She screams things I don’t understand.”
“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.”
“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)
“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. 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.”
“They just stay here, and when something really bad happens to them, we take them to the hospital, and they are immediately sent back. We do the back-and-forth, and in one of these back-and-forths, they will die.”
“What happened to your face?
“I cut it, with a blade.”
And your arms, too…
Cutting was a tactic commonly used by prostitutes to scare away unwanted clients and the police by displaying their supposedly HIV-infected blood.
“Yes, but the more I cut, the more I wanted to cut. So now I stopped for a while. I was very crazy.”
Sassá told me that her rape had not been an exception and that what had been done to her was beyond legal action.
“Pedro, Maria’s husband, grabbed me and took me to the woods. I was not the first. He is in prison now, but not because of what he did to us. It was because he raped a guy who was in a wheelchair… That’s when people wanted to kill him. He hid in a school in the village, but they found him and cut his legs with a sickle.”
As she described the lynching, Sassá painted a picture of Vita’s recovery area as a true extension of local organized crime networks and as a haven for psychopaths.”
Amazing. Endlessly quotable, endlessly sad and beautiful. Too bad nobody cares. Too bad I cannot read a hundred books like this a year, they are too intense, and too much of an expense!
“How does one become another person today? What is the price one pays? How does this change in personal life become part of memory, individual and collective?”
“Psycho-pharmaceuticals 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.”
“Economic globalization, state and medical reform, and the acceleration of claims to human rights and citizenship coincide with and impinge on a local production of social death.”
“Each one was alone; most were silent. There was a stillness, a kind of linquishment that comes with waiting, waiting for the nothingness, a nothingness that is stronger than death. Here, I thought, the only possible distraction is to close one's eyes. But even this does not create a distance, one is invaded by the ceaseless smell of dying matter for which there is language. Like the woman the size of a child, completely curled up in a cradle and blind. Once she began to age and could no longer work for the family, the relatives hid her in a dark basement for years, barely keeping her alive. “Now she is my baby,” said Angela, a former drug user, who most likely has AIDS. She had long ago lost custody of her two children and now spent her days caring for the old women. “She screams things I don’t understand.”
“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.”
“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)
“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. 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.”
“They just stay here, and when something really bad happens to them, we take them to the hospital, and they are immediately sent back. We do the back-and-forth, and in one of these back-and-forths, they will die.”
“What happened to your face?
“I cut it, with a blade.”
And your arms, too…
Cutting was a tactic commonly used by prostitutes to scare away unwanted clients and the police by displaying their supposedly HIV-infected blood.
“Yes, but the more I cut, the more I wanted to cut. So now I stopped for a while. I was very crazy.”
Sassá told me that her rape had not been an exception and that what had been done to her was beyond legal action.
“Pedro, Maria’s husband, grabbed me and took me to the woods. I was not the first. He is in prison now, but not because of what he did to us. It was because he raped a guy who was in a wheelchair… That’s when people wanted to kill him. He hid in a school in the village, but they found him and cut his legs with a sickle.”
As she described the lynching, Sassá painted a picture of Vita’s recovery area as a true extension of local organized crime networks and as a haven for psychopaths.”
Amazing. Endlessly quotable, endlessly sad and beautiful. Too bad nobody cares. Too bad I cannot read a hundred books like this a year, they are too intense, and too much of an expense!
January 1, 2022
the content of this book needs to be discussed everywhere
but it is still silent
but it is still silent
January 22, 2018
Had to walk away from this book in amazement many times, either to cry or to talk about it with the person nearest me. Demonstrates so clearly the ways in which psychiatry, hospitals, and family interact and collude to alienate and exclude defective or troublesome persons. More importantly, Biehl facilitates Catarina's telling of her own story, which, like the stories of all those consigned to social death, need to be heard.
March 9, 2009
If navel gazing is the opposite of informed research, then this is the other opposite of navel gazing.
An ethnography of one person.
Biehl writes so beautifully that one can almost forget that he is actively personifying and attributing meaning to the actions of a very mentally ill person. Its emotional and claims to be theoretical. Its highly involved, and yet claims to be observational.
Very frustrating to read
What the hell, Joao? What the hell.
An ethnography of one person.
Biehl writes so beautifully that one can almost forget that he is actively personifying and attributing meaning to the actions of a very mentally ill person. Its emotional and claims to be theoretical. Its highly involved, and yet claims to be observational.
Very frustrating to read
What the hell, Joao? What the hell.
February 22, 2022
this is actually the best book ive ever read
March 7, 2025
read this one for my sds seminar on prejudice and discrimination - it had me wanting to scream cry and throw up pretty much the whole way through (positive). So incredibly heartbreaking but so so so important. This one has sparked some very interesting and insightful class discussions which I think really improved by reading experience! A very hard read but so good.
April 25, 2007
For all its problems, I think this book is a beautiful combination of narrative, ethnographic detail, archival research, and scholarship. It's much less jargony than other anthropology texts, while retaining a theoretical and academic rigor.
It's a beautiful ethnography/narrative of the life of one woman in a 'zone of social abandonment' in Brazil, detailing the way that the family organization, the medical establishment, and the democratization of Brazil came together to label her as a madwoman, strip away her ability to speak for herself, and make her into what Biehl calls a 'pharmaceutical subject.'
Good reading!
It's a beautiful ethnography/narrative of the life of one woman in a 'zone of social abandonment' in Brazil, detailing the way that the family organization, the medical establishment, and the democratization of Brazil came together to label her as a madwoman, strip away her ability to speak for herself, and make her into what Biehl calls a 'pharmaceutical subject.'
Good reading!
December 30, 2007
My favorite ethnography this year, Biehl's person-centered ethnography is historical, political and personal. Seamlessly connecting macrostructural shifts in the global economy to individual lived experience, Biehl's critical interpretive approach uses the story of one woman to address key questions in medical anthropology. Not surprising that the book won just about every anthropology book award.
December 3, 2013
Vita is a beautiful ethnography and perfect example of a case study done right. Biehl masterfully sculpts the story of Catarina's life through his passion to find answers and through his substitution of the common terminology with powerfully fresh terms such as "social death" and "ex-human." This book will leave the reader heartbroken, but inspired to enact change. It is a must read.
July 29, 2010
A lovely example of a case study. Biehl uses the example of a single woman to explore gendered medical policy, family structure and psychology in Brazil. Theoretically strong and fascinating. I felt that it could have drawn upon bio-cultural theory more.
Read
March 5, 2008absolutely heartbreaking story, brilliant analysis of abandonment in Brazil. beautifully written as well
December 30, 2017
Visceral and insightful. Biehls writing is captivating.
January 2, 2026
Biehl describes how the push for the deinstitutionalization of mental illness in the late 1980s actually resulted in "dehospitalization,” where patients were taken out of psychiatric hospitals and left with no place to go. Families often aided in the process of “social death;” they were eager to “rid themselves” of their unproductive family members. (Catarnia’s mother-in-law wished her daughter-in-law to die). Additionally, "sane" family members had more authority in medical decisions, further denying the patient autonomy. The growing pharmaceuticalization of patients also served to further de-individualize these patients; patients like Catarina were put on a “standard” cocktail of drugs for “psychiatric” patients. A lack of both proper medical charting and a drive to discover a real diagnosis also contribute to one's "social death."
Biehl conducts an immense amount of tedious medical history research in pursuit of understanding more about Catarina’s story. In revealing the various psychiatric diagnoses and copious medications Catarina received, we gain an understanding of how medical care in Brazil is heavily influenced by the social and economic conditions at the time. For example, it was easier to see Catarina as “nervous woman and unfit mother” (p. 167) than work to diagnose her underlying neurological disorder (later, thanks to the help of Biehl, revealed to be Machado-Joseph disease). Catarina became categorized as a “mad woman” and was then subject to pharmaceuticalization, where medication was used to “domesticate” her. The use of medication further stripped her of her autonomy; it became a way for her family to attempt to silence her (through sedation) or blame her for not helping herself when she didn’t want to take medication (which she knew was not treating her real pain). These practices make it clear that society deemed Catarina to be “a body not worth governing” (p. 177).
It is then even more heartbreaking as we discover, through Biehl’s persistence, the real neurological condition that has been inherited in Catarina’s family for generations. Catarina’s (male) family members now have options to deal with this disease – disability, physical therapy, participating in ongoing research, etc. I think highlighting these other family members’ interpretation of the disease for themselves sheds a new light on how gender dynamics contributed to the silencing of Catarina and her medical neglect.
Biehl conducts an immense amount of tedious medical history research in pursuit of understanding more about Catarina’s story. In revealing the various psychiatric diagnoses and copious medications Catarina received, we gain an understanding of how medical care in Brazil is heavily influenced by the social and economic conditions at the time. For example, it was easier to see Catarina as “nervous woman and unfit mother” (p. 167) than work to diagnose her underlying neurological disorder (later, thanks to the help of Biehl, revealed to be Machado-Joseph disease). Catarina became categorized as a “mad woman” and was then subject to pharmaceuticalization, where medication was used to “domesticate” her. The use of medication further stripped her of her autonomy; it became a way for her family to attempt to silence her (through sedation) or blame her for not helping herself when she didn’t want to take medication (which she knew was not treating her real pain). These practices make it clear that society deemed Catarina to be “a body not worth governing” (p. 177).
It is then even more heartbreaking as we discover, through Biehl’s persistence, the real neurological condition that has been inherited in Catarina’s family for generations. Catarina’s (male) family members now have options to deal with this disease – disability, physical therapy, participating in ongoing research, etc. I think highlighting these other family members’ interpretation of the disease for themselves sheds a new light on how gender dynamics contributed to the silencing of Catarina and her medical neglect.
June 28, 2020
This was a really hard book to read. Not in terms of how it was written—it was written beautifully—but in terms of content and the handling of content. The handling of people. I found it held Catarina’s story with patience—but there was something about it that also felt exploitative. Objectifying. I am still left with many complicated questions about what the role of the anthropologist really is and what Biehl could have done differently. But overall, as a book, it does a good job of making me think, bringing me somewhere, introducing me to someone. It’s the afterlife of this book that more worries me. Or I guess the life it never gave the people it owed most.
January 12, 2022
Etnography can sometimes pierce right through you, such powerful are the personal stories narrated and analysed in it.
This is the case with Vita which actually should have been called The Life and Sufference of Catkini.
But that would have given away the impressive amount of surprise that lies in the dramatic reality explored by the anthropologist author, J. Biehl.
This monography is quite recommended when you're dealing with ethnopsychiatry and medical anthropology, or any social science linked with matters of mental & physical health.
If you wish to understand some of the problems in Brazil, then this book is compulsory.
This is the case with Vita which actually should have been called The Life and Sufference of Catkini.
But that would have given away the impressive amount of surprise that lies in the dramatic reality explored by the anthropologist author, J. Biehl.
This monography is quite recommended when you're dealing with ethnopsychiatry and medical anthropology, or any social science linked with matters of mental & physical health.
If you wish to understand some of the problems in Brazil, then this book is compulsory.
September 21, 2024
Vita is a brilliant and tragic ethnographic work of the processes that create human abandonment–would recommend to anyone working in or adjacent to social services, also an approachable ethnography for non-anthropologists. Will be returning to it.
December 7, 2017
highly highly recommend
January 22, 2018
This is life changing ethnography.
February 13, 2019
A piece of art - you really remember it by your very encounter with it. A book deserves to be a "best-seller" for a public audience beyond the academic world.
March 11, 2019
The anthropological inferences sometimes lost me, but this really picked up steam as it went.
March 2, 2023
One of the best anthropological works I've read
February 12, 2024
Shits sad
July 30, 2025
I didn’t realise how influential this book was when I finished reading, but I later recalled this book so many times. Very inspiring and unique writing.
August 8, 2015
One of the most beautiful and devastating ethnographies I've ever read. I recognize its problems. It is not very reproducible. It is hard to know where Catarina begins and ends and where Biehl begins and ends. It is not always clear what he is trying to say, and there are gaps that would be useful to have more information on. His point is not always entirely clear. That being said, this is a sensitive piece of work that looks with empathy and grace at the life of a remarkable woman who was abandoned by family, the medical system, and the state. His privileging of her voice, language, and concerns is beautifully done. I was at times uncomfortable with how things went but it demonstrates the messiness of fieldwork and ethics. I also think he does a fantastic job of tracing what forces affected Catarina's life and how multiple parties influenced and altered the course of life. I could say more but I have to write papers on this sucker, so suffice it to say, highly recommended if you are interested in topics like creative ethnography, social death, biopolitics, regimes of care, etc.
November 5, 2015
Okay okay okay okay. OKAY. this ethnography. is WOW.
I know this is definitely not a pleasure read nor will my review ultimately convince anyone to read a heavy ethnographic account of the mental health industry in Brazilian society. BUT this book is fucking worth it anyway.
I know I am super biased because cultural anthropology was what I studied during college, but this is mind-blowing. PLEASE BELIEVE ME.
I live really close to Princeton University and when I found out the author WORKS at Princeton I pretty much died. I literally, actually, and in all seriousness WENT THERE (its only like 10 minutes away but still) and pointlessly searched the campus attempting to run into him.
I didn't find him.
But I will still attempt in the future.
I know this is definitely not a pleasure read nor will my review ultimately convince anyone to read a heavy ethnographic account of the mental health industry in Brazilian society. BUT this book is fucking worth it anyway.
I know I am super biased because cultural anthropology was what I studied during college, but this is mind-blowing. PLEASE BELIEVE ME.
I live really close to Princeton University and when I found out the author WORKS at Princeton I pretty much died. I literally, actually, and in all seriousness WENT THERE (its only like 10 minutes away but still) and pointlessly searched the campus attempting to run into him.
I didn't find him.
But I will still attempt in the future.
October 13, 2014
This book is not only one of the greatest ethnographic accounts of "the end-station on the road of poverty" but one of the most powerful enquiries into the nodes of existence "where living beings go when they are no longer considered people"
December 15, 2014
This book really opens your eyes to people like Catarina and makes you think about our societies. It makes you question how is it that we cast away our own family simply because they are "different." This is a must read for everyone. Truly enjoyed reading this book despite the heartbreak.
January 20, 2009
You should read this. You just should. It will change your brains. Ethnography is awesome.
May 22, 2009
um. wow.
Displaying 1 - 30 of 39 reviews