Long ago my mother, Utahna, was dying from a brain tumor. There was no way for us, her children, to prevent her death irreplaceably damaging all of our young lives. Her body and its ability to fight such an anomaly was failing; and we were powerless to stop it. Fortunately, there are those that endeavor to enter the war against such entities, illnesses, and diseases in order to save the lives of those entangled within. They practice more than just the art of medicine, but also the craft of power. “Led by medicine, the ‘human sciences,’ through their production of knowledge, developed increasingly refined ‘technologies of power’” (Davenport, pg 312). It goes without saying that in order to control the internal physiological environment doctors have to have power over it. However, such interplay is not without its social consequences. In this paper I’m going to look at some of the ways power works in and through medicine. Namely: the objectification of the body; how impoverished displaced sugar cane cutters in Alto de Cruzeiro suffer “nervosa” as a consequence to the political, social, and medical play of power; and finally, how Angel Bay medical students try to bridge the objectification and social politics in order to truly help their patients.
When my mother woke up paralyzed one morning, the emergency personnel were quick to itemize her condition into blood pressure, temperature, heart rate, what limbs she couldn’t move, where there was pain, and so on. She no longer was Utahna, a poet and mother six, but rather a puzzle that they needed to break down into smaller and smaller pieces in order to find out why her body wasn’t working. In a sense, my mother stopped being a person and became an object. This “objectifying” is when doctors, “transform them into problematic body parts rather than view them as whole human beings in fully contextualized psychological and social environments” (Davenport, pg 311). As the body is broken down into systems then subsystems, the microscopic way the doctor’s view their patients has been coined as the “medical gaze” by Michel Foucalt. The technical discourse that follows only supports the distancing of the patient from the “condition”. One might wonder why there’s a critique against this objective perspective when it seems inevitable or even professional. However, the critique is not about what it takes into account, but rather what it lacks. If the cause or the solution lies outside the physical body, will even the greatest microscope or “medical gaze” be able to find it? An example of this is sorely seen in the impoverished cane cutters of Alto de Cruzeiro.
After a quarter of a century of repressive military rule, the political climate in Alto de Cruzeiro is uneasy. Here the, “dominant exercised their power both directly through the state and indirectly through a merging with civil society… that hegemony operates as a hybrid of coercion and consensus” (Hughes, pg 171). In “Nervoso: Medicine, Sickness, and Human Needs,” Nancy Scheper Hughes indicates that it’s, “into this potentially explosive situation, doctors, nurses, pharmacists, and the first few timid psychologist to appear on the landscape are recruited in an effort to domesticate and pacify an angry-hungry population” (Hughes, pg 211). In Alto de Cruzeiro the power to address the physical ailments of its starving people lies not only on the doctor, but also on the political and social climate. With so many engaged, it raises some questions as to why their physical needs are not being met. Beyond that is why the doctors are treating their patients for “nervoso" and not hunger. “How have these people come to see themselves primarily as nervous and only secondarily as hungry?” (Hughes, pg 177) Two examples of these mortally tired cane cutters are Severino Francisco and Seu Tomas’.
Starting as an eight year old child, Severino cut the cane until he became sick. He like many others had to work the cane on empty stomachs (Hughes, pg 176). They would eat when they could and, when they couldn’t; they would try to sleep till the next day (Hughes, pg 182). Severino continued until the “illness” that spread through his legs and body got too bad for him to work in the fields. After searching for a “cure” he took up the barber profession to provide for his family. “I barely make enough to feed my wife and children. The cacula [last born] cries for milk all the time, but I have to deny her because out of the little besteira that I earn I have to put something aside every week for my medicines.” In addition, it falls to the doctors to sign his disability papers and, therefore, it is in his best interest to turn to them to for help. However, “they just kept sending me home with remedios for my heart, for my blood, for my liver, for my nerves. Believe me, so vivo de remedios [I live on medications]” (Hughes, pg 181). Seu Tomas’ was also prescribed many medications for his “illness” although, in Seu Tomas’ case, he stopped taking certain ones because they “began to offend” his empty stomach (Hughes, pg 183). When asked why they are treating his nerves and not his hunger, he laughed and said, “Who ever heard … of a treatment for hunger? Food is the only cure for that.” He goes on to say that, “It’s easier to get help with remedior. You can show up at the prefeitura with a prescription… but you can’t go to the mayor and beg for food!”(Hughes, pg 184) In both of these examples they were treated at the doctor’s for “nervoso” which is a folk term that manifests like hunger in their physical bodies as headaches, tremors, weakness, tiredness, irritability, angry weeping, among others. How are the doctors of Alto de Cruzeiro going to fight their war on illness if they cannot see their patients in their “fully contextualized psychological and social environments?” And, since they don’t, the consequences to objectifying their patients has become a population that is slowly dying of hunger, yet sees themselves as “ill” or nervous. Nancy Hughes sums up their unfortunate conclusion.
“There are power and domination to be had from defining a population as ‘sick’ or ‘nervous’ and in need of the ‘doctoring’ hands of a political administration that swathes itself in medical symbols. To acknowledge hunger, which is not a disease but a social illness, would be tantamount to political suicide for leaders whose power has come from the same plantation economy that has produced the hunger in the first place. And because the poor have come to invest drugs with such magical efficacy, it is all too easy for their faith to be subverted and used against them. If hunger cannot be satisfied, it can at least be tranquilized, so that medicine, even more than religion, comes to actualize the Marxist platitude on the drugging of the masses” (Hughes, pg 202-203).
As the cane workers are, “paralyzed within a stagnant semifeudal plantation economy that treats them as superfluous and dependent,” they are left with two choices (Hughes, pg 182). They can recognize their political, social, and physical suffering and protest; which may offer them lethal consequences. Or, they can turn to medicine to “cure” their physical crisis. In the hospital, or clinic, the doctors have two choices as well. The first is to take the pain on under the, “technical domain of medicine, where they will be transformed into a ‘disease’ to be treated with an injection, a nerve pill, a soporific” (Hughes, pg 214). While the second is to, “provide a space where new ways of addressing and responding to human misery,” is worked out (Hughes, pg 215). By practicing more than just the art of medicine and the craft of power, one way a doctor can balance the act of “gazing” is by “witnessing”. This is seen throughout the city of Angel Bay where local university medical students learn and practice in homeless clinics.
The ideology of “witnessing” is directly in opposition to how medicine constructs its patients as “objects” (Davenport, pg 316). What Beverly Ann Davenport calls “witnessing” is where the doctor consciously works to “see” the whole patient, “not simply the medical aspects of the patient’s complaint, but also his or her social and psychological environment” (Davenport, pg 318). As Beverly reports on their “quality, not quantity” motto through five micro-practices, the conflict between “gazing” and “witnessing” becomes more apparent. It starts with a gentle, thorough probing of the patient’s history. For example, when a first year student asks how long he should let the patient “ramble on” before he jumped “to the important medical stuff,” the second year student points out that allowing the patient to “ramble on” was a powerful interview technique. She asserts basically that, “what is ‘medically important’ would be revealed in the ‘witnessing’ process” (Davenport, pg 318-9). Otherwise, treatment might end up like it did for the drug user that moved to Angel Bay City from the East Coast. In that case, “the ultimate irony … is that a heroin-user is advised to quit smoking in order to take birth control pills to relieve the symptom of irregular periods, which is caused by her heroin addiction in the first place” (Davenport, pg 320).
Another aspect of “witnessing” is thinking of the patients as subjects; where the doctor sees both the disease and the person who is suffering from it. One doctor tackles this by not referring to his patient in third person singular, but rather by name. It’s not, “a 46-year-old white man who comes in with a history of …” but rather, “So I met Bill. And Bill was disheveled…” (Davenport, pg 321-2) When charting or meeting with other doctors they tend to depersonalize their patients and the discourse becomes more of “gazing” and less about the human around it. For my mother, her extreme poverty and physical beatings from her father when she was young never came into her discourse. Every time she would seek help with her headaches the doctors wrote her off a prescription or indicated that her pain was imagined and did nothing. For decades, no tests were run because they never looked beyond her body for a cause and, therefore, they never felt expensive tests were warranted. Like for my 40 year old mother, “gazing” rather than “witnessing” costs and destroys lives.
Objectification of the body may simplify medical learning, but it complicates patient care. As seen in the cane cutters of Alto de Cruzeiro, the medical removal of humanity from the people makes them political and social power tools. Unless new ways of responding to human misery are generated, and the objectification of the patient is challenged, then the loss and destruction of lives will continue. The students of Angel Bay have begun this process with the “witnessing” of their patients. Fortunately, there are those that endeavor to enter the war against illnesses, and diseases in order to save the lives of those entangled within. “Seeing” their patient may be their next great step.
Bibliography
Davenport, Beverly Ann. 2000. "ARTICLES - Witnessing and the Medical Gaze: How Medical Students Learn to See at a Clinic for the Homeless". Medical Anthropology Quarterly. 14 (3): 310.
Scheper-Hughes, Nancy. 1992. Death without weeping: the violence of everyday life in Brazil. Berkeley: University of California Press.
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