Forms of subjectivation and precariousness of life: Contradictions in rural settings

This theoretical paper aims to examine some of the interfaces between rural settings and the field of mental health. First, living conditions in rural regions will be discussed, exploring rurality from a perspective of vulnerability and its impact on psychological health. Next, we will expand this approach by analyzing other analytical perspectives, namely Judith Butler’s (2018) essay on the precariousness of life and Mbembe’s (2018) necropolitics. Finally, this paper seeks to contribute to research on the living conditions and mental health of rural populations, and to promote territorial practices. Consideration will also be given to the specific lifestyles and needs of this community – without disregarding deteriorating conditions of inequality and insecurity arising from the conservative political discourse underway in our society.

The research group "Forms of subjectivation, public policies, and contexts of vulnerability", linked to the Psychology Graduate Program of the Universidade Federal do Rio Grande do Norte, encompasses four domains: Psychology and rural settings; Gender, territory, and lifestyle associations in contexts of poverty; Mental health and psychosocial attention in the National Health System (SUS); and Work in settings of social vulnerability: conditions, significance, and public policies. This theoretical paper aims to provide an overview of discussions undertaken by the research group in recent years, specifically within the topics of psychology and rural contexts, and their interfaces with the field of mental health.
First, the living conditions in rural regions will be discussed, exploring rurality from a perspective of vulnerability and its impact on mental health. Next, we will expand this approach by investigating other analytical perspectives, such as Judith Butler's (2018) essay on the precariousness of life and Mbembe's (2018) necropolitics. Finally, this paper seeks to contribute to research on the living conditions and psychological health of rural populations, and to promote territorial practices. Consideration will also be given to the specific lifestyles and needs of this community -without disregarding deteriorating conditions of inequality and insecurity arising from the conservative political discourse underway in our society.

Living conditions and rural settings
According to the United Nations (2015), in 2014, more than three billion people lived in rural areasrepresenting 46% of the world's population. Most live in vulnerable situations, characterized by poverty, lack of basic sanitation, access to health services, education and care, poor housing, etc.
The International Fund for Agriculture Development (Fundo Internacional de Desenvolvimento Agrícola [IFAD], 2016) states that poverty rates are systematically higher in rural versus urban regions, in most parts of the world including Latin America. In Brazil, it is estimated that only 15.6% of people live in rural areas (Instituto Brasileiro de Geografia e Estatística [IBGE], 2010) -a result of depopulation seen in the country in recent decades -and that 25% of this group live in extreme poverty (MDS, 2014;PNUD:OPEA:JFP, 2017).
People living in the countryside, forest, or by the water form communities with lifestyles and work predominantly connected to the land, sharing a history marked by poverty and the consequences of intense inequality constituting Brazil's social formation. It is these populations who suffer from a lack of development in various sectors, such as education, health and social security. That is, they are most affected by isolation, invisibility, and poor public policy outreach (Dimenstein, Macedo, Leite, Dantas, & Silva, 2017).
Literature informs the conditions of vulnerability that impact the lives of rural people. These circumstances are a product of the Brazilian countryside's long social formation history, dating back to colonialism. Uncovering these hierarchical relationships contributes to an understanding of the vulnerability process, despite progress observed in recent decades including a set of policies aimed at addressing social inequalities, such as Programa Bolsa Familia (Family Allowance Program), Programa de Fortalecimento da Agricultura Familiar (Family Farming Support Program) (PRONAF), Luz para Todos (Electricity for Everyone), and health and social assistance strategies targeting rural inhabitants and forest dwellers (Leite, Dimenstein, Dantas, Macedo, & Freitas, 2016).
In a recent paper, Pinto et al. (2018) analyzed the country's Human Development Index of rural municipalities, which is based on a set of indicators that facilitate an understanding of our rural reality, especially in terms of longevity, education and income.
The authors emphasized the gap separating rural and urban citizens, as well as the contrast in schooling and income, especially between Brazilian regions.
It is known that rural inhabitants' low socioeconomic indicators are a consequence of local/global economic and political interests -having historically amplified the exploitation of natural resources and human beings. According to Wanderley (2001), this also leads to the loss of vitality in rural areas, the expansion of socially empty spaces, and the precariousness of health and living conditions.
To make matters worse, the Summary of Social Indicators (SIS) published by IBGE (2018) shows increased poverty between 2016 and 2017 in Brazil. During such times of economic, social, and ethical-political crisis (going on in Brazilian society since 2015), worsening rates of unemployment, poverty and debt are noted, especially among citizens of rural areas. The report points out, among other things, that: "Due to the persistent deterioration of labor market indicators and an increase in the proportion of self-employed and undocumented workers (who receive lower pay), the inequality indicator rose among the employed…and this disparity was more pronounced in agriculture" (p. 24).
The urban population's average household per capita income is almost three times higher than that of rural residents (R$ 882.6 and R$312.7 (USD210.00 and 75.00), respectively). As for adult education levels, 60% of people over 18 years of age, living in urban regions, have completed elementary school, compared to 26.5% of those in rural districts. In terms of life expectancy at birth, urban populations live on average 3 years longer than their rural counterparts, 74.5 years compared to 71.5 (p. 18).
In addition, the increased use of land as a means for exploitation and enrichment of Brazilian and transnational elites, has led to a resurgence of violence, aggravation of environmental conflicts, and an increase in the number of countryside deaths -among other problems, which affect the deterioration of this group's general health conditions, in particular mental health.
Thus, there is a close relationship between life events characterized by intense inequalities, injustices, racism, and gender discrimination, and the experience of psychological distress. Psychological distress is not listed as one of WHO's neglected tropical diseases (e.g. dengue, Chagas disease, leishmaniasis, leprosy, malaria, schistosomiasis, and tuberculosis), which are defined as "diseases that not only prevail in conditions of poverty, but also contribute to maintaining inequality" (Brazil, 2010, p. 200). Nevertheless, it is considered a large part of the global burden of disease -yet, mental health has traditionally been neglected by public health initiatives.
Some researchers have underscored the delicate balance of poverty, stressful events, limited social and economic recourses and other demographic disadvantages with detrimental effects on emotional well-being (Pereira et al., 2017). Macedo et al., (2018) and Dimenstein, Macedo, Leite, Dantas and Silva, (2017a) investigated the vulnerability process of rural populations and the increased incidence of common psychological disorders and alcohol/drug abuse in agrarian reform settlements and quilombola (hinterland) communities.
This scenario poses a challenge not only for these people's daily life, but also for the formulation of public policies that reach and respond to the needs and specificities of rural settings. According to De David (2017), "there is a large social and cultural diversity in the Brazilian countryside, responsible for a multifaceted mosaic of people, activities, relationships, habits, traditions, and conceptions that produce complex, dynamic, and rich rural backgrounds" (p. 5). Moreover, these inhabitants are connected to the unique history of their regions' land and agriculture. Therefore, we must not forget the progressive development made by agribusiness in the country's southern and mid-western regions, the extractive character of the northern region, and the coronelista (rural political boss) patterns that marked the lives of northeastern rural workers. These diverse characteristics granted particularities and specificities in regard to the life and work dynamics of these populations.
For this reason, when thinking about rural contexts, it is important to overcome dichotomous and antagonistic social views that have historically depicted urban environments as an ideal of modernity and technological advancement, over a rural one seen as backwards, 'primitive', and behind modern times (Matijasevic & Ruiz Silva, 2013).
Overcoming such views requires recognition of a rural world populated by a variety of social relations, the existence of a grand sociocultural heritage, and historical methods for resisting the damaging modernization effects on agriculture (Alentejano, 2012) -which promised enhanced quality of life, but actually resulted in uprooting, exploitation of rural workers, expropriation, and environmental degradation.
These lifestyles are shaped by countless social identities, various types of relationships with the land and natural resources, as well as unique community experiences from indigenous groups, quilombola, riverine and extractivist communities, family farmers and farm hands, etc. Finally, they are identities that, despite having their historical social reproduction blocked (Wanderley, 2014), continue to resist and make themselves visible in rural areas.
Given the diverse territory, identity, and lifestyle configurations, some authors have proposed the idea of rurality as a way to counteract a hegemonic view that associates the countryside with a specific productive sector, in order to highlight the emergence of new processes that have substantially altered economic and sociocultural relations in rural places such as pluriactivity, rural tourism (Carneiro, 2012) and the incorporation of new technological standards.
This multifaceted and ever-changing background, still faced with adverse living conditions, forms a complex network of social determinants that affect the process of health and disease in rural inhabitants. A study conducted in a number of Brazil's northeast rural settlements highlights the interdependence between socioeconomic conditions, habitat and living environment characteristics, cultural patterns, experiences and individual life trajectories as elements that shape subjects' mental health status (Dimenstein et al., 2017a). The authors use the social determinants of mental health concept as a basis for their analysis, leading to a scenario of conditions that must be thoroughly analyzed in order to understand the subtleties of psychosocial suffering in these contexts (Dimenstein, Siqueira, Macedo, Leite, & Dantas, 2017b).
The complex interrelation between rural regions and mental well-being is impacted by environmental aspects of people's life circumstances, such as the drought phenomenon and its psychological implications (Alpino, Sena & Freitas, 2016;Camurça, Alencar, Cidade, & Ximenes, 2016). Among the main psychosocial effects analyzed by the present article, the following are highlighted: stress, anxiety, depression, suicide, and increased alcohol consumption; which when overlapped with agricultural and livestock production losses, lead to financial difficulties, loss of social and family support, and exacerbate situations of food and nutrition insecurity.
Another element linked to mental health in the country is labor performed under precarious conditions, affecting the health of rural workers, as concluded by Riquinho and Hennington (2014), Santos et al., (2017), and Rocha and Oliveira (2016), regarding the clinical profile and health problems of tobacco farmers excessively exposed to pesticides.
Added to the issues arising from precarious working conditions, low education and lack of access to public policies, are inequalities and racial discrimination, especially related to specific rural landscapes, as is the case with land reform settlements. Research in the Northeast has identified a strong relationship between living conditions, common psychological disorders, and problematic alcohol use between men and women .
Another important connection concerns the situations of vulnerability combined with the specificities of gender relations in rural territories. Leite et al., (2017) found unique experiences of suffering between men and women. With men, the agricultural workload, precarious work conditions, loss of physical vitality, and the emergence of chronic diseases appear as determinants of mental health. For women, housework (considered a second shift), number of children, gender-based violence from an intimate partner, stressful life events such as loss of close relatives, and separation, are factors that worsen mental distress.
In this case, violence against women and domestic violence in the countryside stand out as a complex and isolated phenomenon, present in rural familiesespecially in those with financial difficulties and geographical isolation, which, when added to a strong patriarchal culture, prevents them from activating the few existing protective services (P. Scott, Nascimento, Cordeiro, & Nanes, 2016;Silva, Silva, & Pinto, 2015).
However, political participation and action have increased women's degree of autonomy, as social movements provide support in addressing these types of violence (P. Scott et al., 2016). From this perspective, despite the challenge of confronting gender hierarchies (part of gender vulnerabilities), rural group action (notably those of rural workers) constitute forms of resistance that defy social and power relations (Bonfim, Costa, & Lopes, 2013;Oliveira & Leite, 2016).
Social movements observed in the country are highly persecuted, putting even more at risk the possibility of overcoming current daily life vulnerabilities. Thus, in the following section of this paper, we will discuss how the barrier to overcome such living conditions is a broader political project, joining the macropolitics of capitalism (anchored in colonial knowledge/power relations) and micropolitics that impose certain forms of extreme precariousness or the annihilation of their existence.

The making of precarious lives: challenges to the field of mental health in rural settings
Vulnerability as a theoretical concept has been widely used by both public policy and scientific development. The term's use has several nuances in literature, sometimes depicted as a common, meaningless term, and occasionally gaining theoretical layers, becoming a comprehensive vehicle for analysis (Carmo & Guizardi, 2018;J. Scott, Prola, Siqueira, & Pereira, 2018). Paulon and Romagnoli (2018) consider the complex and multifactorial nature of vulnerability undeniable; influenced by economic, environmental, health, social, and personal issues -facilitating analysis of the living and health conditions of individuals, families, or communities.
Despite the concept's inherent polysemy, it is important to note certain meaning repertoires in relation to the living and health conditions of rural populations. A trend that is evident in research is a naturalized or substantiated understanding of vulnerability, in a causal relationship between precarious living conditions and their effects on particular social groups (Paulon & Romagnoli, 2018). By contrast, other theoretical positions argue in favor of vulnerability as a social and political movement strategically developed and directed at certain societal groups. The effect of this direction is a calculated precariousness of life. In this sense, Butler (2018) states: "Precariousness" signifies a politically induced situation in which certain populations suffer more than others the consequences of deteriorating social and economic support networks, and are unequally exposed to harm, violence, and death. Hence, as aforementioned, precariousness is a differential distribution of the precarious condition (p. 41).
Thus, in relation to certain groups in society, there are a series of meticulous interventions developed that push these subjects into less visible and unprotected regions. Along these lines, another significant concept used to interpret precariousness of life is that of Mbembe (2018). By radicalizing and updating Foucault's notion of biopolitics (2008,2014), it highlights the ongoing regime of making disposable bodies, and "worlds of death" (p. 17), as a contemporary attempt of subjugation and destruction of lives.
This debate has been possible by consulting postcolonial and colonial perspectives that have contributed to an elaboration of the ontological and epistemological control of knowledge production that neglects dominant relations established and maintained in contemporary times (Ballestrin, 2013). Therefore, in the 21st century, it is possible to propose the notion of neocolonialism, a type of imperialism combining the operation of sovereign states with interests of global capitalism and the activities of large international corporations (Miglievich- Ribeiro & Prazeres, 2015).
These authors warn that populations on the periphery of capitalism will suffer the most devastating impacts from the standpoint of exposure to poverty, hunger, violence, different forms of racism, precarious work, etc. Problems related to access and distribution of land that unequally affect small farmers, rural settlers, landless workers, wage workers, aboriginals, quilombolas, and squatters, can be specifically underscored when addressing rural inhabitants. This is noticeable when observing the international race for land acquisition and speculation, displaying transnational corporation competitiveness for the purchase and expropriation of land in so-called underdeveloped countries, marginalized in the international division of labor as commodity producers. As a result of this global movement, at the local level, agribusiness expansion is occurring to the detriment of family and peasant farming production, the escalation of countryside conflicts, and the decimation of traditional and indigenous peoples, with an exponential increase in deaths each year. Rurality is shaped by power relations in which violence, and consequently death, is paradoxically a condition of life (Ribeiro, Fernandes, & Oliveira, 2018).
In this sense, another extinction strategy includes the eradication of languages, traditional knowledge, non-hegemonic religions, and different worldviewsdepicting a clear attempt to destroy the culture and individuality of these communities. Added to this, are high levels of violence in the countryside, such as recurring murders and massacres against community leaders 1 , environmental disasters, and the incorporation of modern agricultural systems that endanger biodiversity (e.g. use of large agribusiness monocultures and intensive use of pesticides) (Pignati et al., 2017).
From this perspective, the urgent question is how to deal with the surplus and disposable populations produced by this development. If precariousness is understood as a rationale for governing life, it is done through deliberate choices and decisions that within the state will create minimum conditions for these lives to survive, albeit under precarious conditions. Taking into consideration the "ongoing geopolitics of dispossession in agribusiness land acquisitions, of which the greatest victims are traditional populations occupying their original territories" (Mondardo, 2019, p. 1), it is easy to understand the power relations and colonialism that still prevail in countries like Brazil. The aforementioned inequalities that strike urban and rural populations need to be considered vectors for their slow and progressive extinction, forcing them to migrate or remain, either way in precarious conditions -eventually resulting in the death of various facets of life. According to Lima, in Brazilian contexts, the power of necropolitics is visible in the prison system, in homeless populations, in urban apartheids both in large and small Brazilian cities, in relevant data, in the genocide of blacks, mostly young and male, in the outbreak of vigilante groups, in psychiatric hospitals, in the lines outside offices of public defenders, in emergency rooms and hospital emergencies, among other places (2018, p. 28).
In addition, there is currently profound instability regarding the guarantee of rights of traditional and indigenous groups whose land has been ancestrally inhabited or conquered as an environmental reserve. Such instability has been promoted in successive threats publicly announced by the current government, questioning aboriginal reserves and the territories of quilombola communities while speaking in favor of supposed economic development through the indiscriminate extraction of iron ore and timber. As a result, clashes have escalated between indigenous people, loggers and miners (with episodes of violence and murder of aboriginals and their leaders).
Thus, when historically analyzing public and social policies aimed at rural citizens, we observe that they have been excluded from the scope of protection and guarantee of rights until recently, and that even after some achievements, the possibility of regression and loss of progress is a pressing reality today. Only after promulgation of the 1988 Constitution, was it possible to implement Rural Welfare, universal access to the National Health System and subsequently, the National Social Services System.
As understood by Butler (2011;2015), if precariousness is part of a contemporary capitalist regime and there is an unequal distribution of vulnerabilities, significant ethical questions arise about life in the countryside. How are rural areas suffering the effects of this rationale? Is life in the countryside possible? It is essential to deregulate normative frameworks that contribute to the devaluation of certain social groups, making political rationality and intelligibility more widespread and accessible, ensuring the social protection of rural communities. In this sense, context-based culturally sensitive mental health services, integrated within subjects' psychosocial network and life circumstances is a necessary scope of public policies.
The National Policy of Integrated Health for Rural Populations and Forrest Dwellers (Ministério da Saúde, 2013), as well as the National Policy of Mental Health, Alcohol, and other Drugs (Ministério da Saúde, 2003), have been shown to help increase visibility of specific health demands in the countryside. Despite the limitations still present in accepting the particularities of rural groups and forest dwellers, both policies have the potential to develop methods that dismantle processes of standardization, psychologization, and pathologization, especially in managing diversity within the health sector when individuals are not in an urban setting.
This propels a generation of knowledge committed to criticizing essentialist and universalizing matrices, highlighting the way coloniality of knowledge/power (Quijano, 1992) uses a model of standard subjectivity and ideas such as deficit to propagate disruption and disability in various ways of life. Moreover, it leads to the recognition of footprints left by colonialism in the way people interpret their daily lives, mainly in situations of inequity, exploitation, and social exclusion and the silencing and normalization mechanisms of those who resist and dissent.
Our current situation is particularly worrying, as this continuous exercise of recognition/deconstruction/ reinvention of knowledge and practices that position us beyond the walls of colonialism has been strongly constrained by conservative and undemocratic forces underway since 2016, especially after President Dilma Roussef's impeachment and the new conservative government's rise to power, aligned with obscurantist forces that seek to radicalize the neoliberal and implosive project of democracy.