Cult Med Psychiatry. 1988 Jun; 12(2): 141-200.

Angels with wet wings won't fly: maternal sentiment in Brazil and the image of neglect.

Nations MK, Rebhun LA.

Project HOPE, Fortaleza, CearÃ¡, Brazil.

Current theories of fatalism and neglect and current descriptions of childhood illness in impoverished Northeastern Brazil are evaluated. Findings of an ongoing multidisciplinary project indicate that neglect and fatalism theories are incomplete as applied to the Brazilian Northeast. Intensive interviews and observations with bereaved mothers and traditional healers show that mothers' failure to obtain medical care for severely ill children is due more to real-life bureaucratic and geographic barriers to access than to fatalistic or neglectful attitudes on the part of the poor, that mothers' flat affect in response to infant deaths is due more to folk Catholic beliefs than to lack of emotional attachment to infants, that fatalistic statements are often post hoc and do not indicate fatalistic behavior, and that decisions about whether to treat severely ill infants are made by mothers and families in consultation with traditional healers in accord with a folk system of classification of high risk infants. What have been described as "death accepting," "pathogenic," and "ethnoeugenic" attitudes are part of a folk ethical system developed to guide reactions to terminal childhood illness. We argue that human behavior, especially in the realm of health, cannot be understood without reference to both biomedical and psychosocial realities.