‘Nervos’ is a health phenomenon experienced by the people of Alto do Cruzeiro in Brazil. This essay will center around the implications of nervos existing as an ‘illness’ in this Brazilian society following the ethnographic works of Nancy Scheper-Hughes. We will begin therefore, with an explanation of Nervos, discussing the medicalisation of hunger. The affluence of biomedicine will then be described to demonstrate how much its influence has changed the response to illness across the globe with a focus on ‘curing'. The essay will end with by linking the former arguments with a discussion of the social body as a cultural symbol of society.
Scheper-Hughes explains in her ethnography that Alto people believe they suffer from nervos, which can be caused by ‘fear nerves’, ’overwork nerves’ or from not sleeping enough. These three symptoms can correspond to stress, overworking and sleep deprivation respectively, yet this creation of Alto specific diagnostic labels represents their underlying values of medicalisation. Though the Alto people experience symptoms correlating with hunger and starvation, they believe that this ‘illness’ is not caused by hunger but the quasi-medical term nervos, and there is no explicit recognition of hunger. The symptoms Scheper-Hughes describes are often psychological, which are also reflected in metaphors used by the Alto such as “weak” or “off-balance” to describe their psychological state of illness. These symptoms fit the biomedical medical model of hunger, which will be critiqued in more detail later, but in essence hunger is consistently denied. In this community, hunger has been medicalised and the consequential reality of their experience has been turned away. This ‘psychological issue’ requires medication, which is attractive to an illiterate population as it ensures hope, though it is falsely driven. Money is being spent on an illness through the failure among doctors to acknowledge malnutrition as the core behind nervos. Scheper-Hughes describes how doctors are much more likely to prescribe sleeping pills and vitamins, as the medical knowledge is too lacking to transform this folk syndrome into an understanding of reality.
The confusion of the ‘illness’ can be highlighted in more depth through a specific case study of Celia, the sorceress in the Alto community. Those who liked her would blame her ‘nervos’ on her hardworking nature, however those who feared her “accused her of witchcraft dismissed nervos as secondary to her ‘true' illness: lepra (leprosy) resulting from her ‘sick’ and ‘dirty’ blood… they pointed to Celia’s many moral infractions” (Scheper-Hughes 1993, 191). This case emphasises how deeply embedded the false nature of starvation and poverty have been buried into society. Reality is prominently covered and replaced by cultural morals translated into medicalisation. Scheper-Hughes explains how "a hungry body exists as a potent critique of the society in which it exists, a sick body implicates no one” (1993, 174); conditions of poverty and the hunger it entails are replaced with metaphors, as reality is “too painful to think about” (1993, 175). In sickness there is no one to blame but the individual, society is not at fault. Illness is also something that has associations with having a ‘cure’; a much more desirable problem than a large-scale social phenomenon of hunger. In hunger there is an implication that there are holes in society and there is fault on the community. This is why Alto people have tried to brand nervos as an individual based issue. Starvation is an enormous part of poverty, however the Alto people are removing their community from accepting this reality and are therefore changing it into something easier to think about with much less implication.
The medicalisation of hunger allows nervos to exist as a medical issue rather than a socio-economic one, linking strongly to the affluence of biomedicine and the phenomenon of curing. Biomedicine has become a dominating force across the globe. It has provided ground breaking medical discoveries saving millions of lives, whilst also existing as a force that ‘cannot’ be contested. This is due to the assumption of medical universalism, which Obeyesekere discusses in their work on depression and Buddhism in Sri Lanka. Obeyesekere uses ethnography on depression to explain the prestige and culture of modern medicine as being both profound and consequentially nearly impossible to argue. This profoundness has led to the establishment and concretisation of diseases such as depression, with the western biomedical model being the correct one. Biomedicine is able to use the science of ‘absolute truth’ to claim monopoly on health phenomenons. This ideology explains through nervos, the desire to use medical models to account for reality demonstrating how biomedicine has changed the fundamental response to illness. This desire to theorise and in turn medicalise is also expressed in Weber’s theory of rationalisation. Obeyesekere deploys this theory showing how the "affects exist more or less in a free-floating manner, waiting a different symbolic formulations: their conceptualisation as a disease" (1985, 148). It is within this western need to rationalise annd conceptualise society, that the Alto people have also decided to medicalise their experience following a desire to understand ‘illness’ and adopt a medical cure.
The medicalisation of hunger therefore has strong connections to the phenomenon of curing. Medicalisation has created a space where ‘cures’ seem directly linked to illness. By medicalising hunger, Alto people believe they have opened themselves to a cure through biomedical explanation. Curing unfortunately does not always directly correspond with illness, which Ivan Illich explains in his work, ‘medical nemesis’. Illich is critical of this rise in medical dominance, arguing that the industrialisation of medicine causes ‘Social Iatrogenesis’:
“health care is turned into a standardised item, a staple; when all suffering is ‘hospitalised’ and homes become inhospitable to birth, sickness and death; when the language in which people could experience their bodies is turned into bureaucratic gobbledegook; or when suffering, mourning and healing outside the patient role are labeled a form of deviance” (Illich 1976, 41)
This theory reflects the Alto people, as it expresses the inherent harm done through medicine being bureaucratised and becoming so globally prominent. It becomes immensely difficult to contest and the ideal of a cure is therefore adopted by people in Alto as an explanation for their suffering. Illich implies in the quote above that medicalisation is a social ‘excuse’ for deviant behaviour such as Celia the sorceress and creates a standard of life that conforms to the medical production of knowledge. The lack of contestation and immense trust in medical knowledge works to explain the influence on communities such as Alto do Cruzeiro. Medicalisation has been constructed as something with a ‘cure’, which Illich critiques as flawed in how it assumes universal healing. Edmonds similarly references the danger of ‘curing’ regarding implications of the language and ideals of medicalisation. In his ethnography also in Brazil on plastic surgery, beauty works as a ‘cure’ for mental health in the same way that medicine acts as a ‘cure’ for nervos. The cures are dangerous as they are not addressing the cardinal roots of the issues in either community. Biomedicine has unintentionally created a space of dominance where it has massively influenced the response to illness. "Often the patient will respond to the doctor's explanations by shifting his of her explanatory model of illness toward the physician's model, and thus making a working alliance possible" (1990, 190), is Scheper-Hughes’ argument that we become so susceptible to fit the medical mould. Scheper-Hughes went onto apply this theory of medicalisation to the Alto people, linking biomedical power and a yearning desire for cures to this Brazilian experience.
The force of the biomedical model as well as inherent cultural existences act as frames and symbols for the 'social body’. Becker’s work raises the fundamental question, to whom does the body belong? Becker does a cross-comparison of American and Fijian cultures to highlight "the impact of culturally specific notions of personhood on the experience of embodiment… core cultural values are encoded in - among other things - aesthetic or moral ideals of body shape” (1994, 100). Health and cultural values are massively embodied through the social body. This social body does not then necessarily belong to the individual as their body is a symbol of their society and culture. Biomedicine also plays a part in this culturation of the body, which is embodied via the medicalised Alto body. Values of Alto society are reflected in the social body, which medicalisation of hunger and consumption of medicine are intrinsic parts.
This essay has delved into the depths and complexities of nervos as experienced by the people of Alto do Cruzeiro. The implications of nervos embodying a medicalisation of hunger were investigated through the affluence of biomedicine. Biomedical industrialisation has played a core role in the Brazilian response to illness, demonstrated through the associations it has with curing. Inherent cultural values as well as biomedicine were also seen to be embodied by the Alto people highlighting a prominence in the social body acting as a cultural symbol and window into society.
Becker, Anne. 1994. Nurturing and negligence: Working on others’ bodies in Fiji in T. J. Csordas (ed.) Embodiment and experience: the existential ground of culture and self. Pp 100-115. Cambridge University Press
Edmonds, Alexander. 2010. "Introduction" in Pretty Modern: Beauty, Sex and Plastic Surgery in Brazil. Durham. Duke University Press.
Gananath Obeyesekere. 1985. “Depression, Buddhism, and the work of culture in Sri Lanka.” In A. M. Kleinman & B. Good (Eds.), Culture and Depression, (pp. 134- 152). Berkeley: University of California Press.
Illich, Ivan. 1976. Medical nemesis. 1st arg. New York: Random House, Inc.
Lock, M. and Nguyen, V-K. ‘Introduction’ in An Anthropology of Biomedicine. Chichester: Wiley Blackwell. 2010.
Scheper-Hughes, Nancy. 1990. Three Propositions for a Critically Applied Medical Anthropology. Social Science and Medicine 30(2): 189-197.
Scheper-Hughes, Nancy. 1993. “Nervoso: Medicine, Sickness, and Human Needs” in Death Without Weeping: The Violence of Everyday Life in Brazil. Berkeley: University of California Press, pp. 167-215