Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety - Softcover

Carr, E. Summerson

Softcover

ISBN 10: 0691144508 ISBN 13: 9780691144504

Publisher: Princeton University Press, 2010

Synopsis

"Scripting Addiction" takes readers into the highly ritualized world of mainstream American addiction treatment. It is a world where clinical practitioners evaluate how drug users speak about themselves and their problems, and where the ideal of 'healthy' talk is explicitly promoted, carefully monitored, and identified as the primary sign of therapeutic progress. The book explores the puzzling question: why do addiction counselors dedicate themselves to reconciling drug users' relationship to language in order to reconfigure their relationship to drugs? To answer this question, anthropologist Summerson Carr traces the charged interactions between counselors, clients, and case managers at 'Fresh Beginnings', an addiction treatment program for homeless women in the midwestern United States. She shows that shelter, food, and even the custody of children hang in the balance of everyday therapeutic exchanges, such as clinical assessments, individual therapy sessions, and self-help meetings. Acutely aware of the high stakes of self-representation, experienced clients analyze and learn to effectively perform prescribed ways of speaking, a mimetic practice they call 'flipping the script'. As a clinical ethnography, Scripting Addiction examines how decades of clinical theorizing about addiction, language, self-knowledge, and sobriety is manifested in interactions between counselors and clients. As an ethnography of the contemporary United States, the book demonstrates the complex cultural roots of the powerful clinical ideas that shape therapeutic transactions - and by extension administrative routines and institutional dynamics - at sites such as 'Fresh Beginnings'.

About this title

About the Author

E. Summerson Carr is assistant professor at the School of Social Service Administration and an affiliated faculty member in the Department of Anthropology and at the Center for Gender Studies at the University of Chicago.

From the Back Cover

"Scripting Addiction is an original and meticulous ethnographic account of a decidedly post-Freudian 'talking cure, ' in a treatment program for drug addiction. One of the book's notable successes is its account of how clients acquire skills necessary for reading, analyzing, and strategically responding to the social-service transactions that are integral to their lives."--Allan Young, McGill University

"Summerson Carr explores the consequential nexus of language, personhood, therapy, welfare policy, and social-work practice with imagination and subtlety. Deeply textured and intellectually exhilarating, Scripting Addiction is a rich and revelatory account of a specific therapeutic site and an extraordinary model for attuned, reflective, and generative ethnography. This is certain to become a classic in the anthropology of complex institutions--and of the broader ideologies and social relations with which they are entangled."--Donald Brenneis, University of California, Santa Cruz

"Pathbreaking. The book incorporates a fine-grained ethnography of drug treatment and treatment philosophies, and will make a substantial contribution to our understanding of how language and identity function in this institutional setting. Carr displays a deft facility for articulating a number of important perspectives in social work, drug therapy, social theory, and linguistic theory. Scripting Addiction is a scholarly masterpiece."--Gregory M. Matoesian, author of Law and the Language of Identity

"A fascinating contribution to scholarship. Carr has very effectively, thoroughly, and skillfully used ethnography and sociolinguistics to empirically demonstrate the dark side of clinical language practices. Her careful linguistic approach methodically shows how therapeutic language can be used to constrain rather than open up possibilities."--Jerry Floersch, author of Meds, Money, and Manners: The Case Management of Severe Mental Illness

Excerpt. © Reprinted by permission. All rights reserved.

Scripting Addiction

THE POLITICS OF THERAPEUTIC TALK AND AMERICAN SOBRIETYBy E. Summerson Carr

PRINCETON UNIVERSITY PRESS

Copyright © 2011 Princeton University Press
All right reserved.
ISBN: 978-0-691-14450-4

Contents

List of Illustrations..............................................................ixAcknowledgments....................................................................xiIntroduction Considering the Politics of Therapeutic Language.....................1Chapter One Identifying Icons and the Policies of Personhood......................23Chapter Two Taking Them In and Talking It Out.....................................49Chapter Three Clinographies of Addiction..........................................85Chapter Four Addicted Indexes and Metalinguistic Fixes............................121Chapter Five Therapeutic Scenes on an Administrative Stage........................151Chapter Six Flipping the Script...................................................190Conclusion.........................................................................224Notes..............................................................................239References.........................................................................279Index..............................................................................317

Chapter One

Identifying Icons and the Policies of Personhood

Introduction: Politics as Usual

On a sunny August morning in 1996, flanked by two broadly smiling, casually dressed African American women, President Bill Clinton "ended welfare as we kn[e]w it" with a resolved stroke of his pen. Though the blossoming scene of the White House Rose Garden and the beaming smiles of the chosen cast of characters suggested that America's poor and downtrodden had finally found their way under the sun, the "end of welfare" was terribly unseasonable. Despite the New Democratic promise to dismantle the federal AFDC program only if and when the state could guarantee affordable health care, a living wage, and a "dignified and meaningful community service job," none of these conditions had (or have yet) been met. Additionally, with the minimum wage set at $4.75 an hour, an average of 33 percent of poor families' income devoted to child care, and a myriad of federally funded social programs decidedly devolving, the forecast for the first generation of the country's poorest finding themselves without social security since 1935 was very gray indeed.

However, in light of the coming elections and the tremendous unpopularity of welfare (even among welfare recipients, as Clinton's script would have it),4 these threatening conditions were widely overlooked. After all, the problem of welfare, as politicians and their constituents left and right charged, was that poor people like those gathered in the Rose Garden that day came to depend on it, even if it was substantially shy of a living wage. Notably, poor people's "dependence" was cast as not only—nor even primarily—economic in nature. Dependence had weaseled its way down into the impoverished psyche and then proliferated, through intergenerational and (sub)cultural transmission. What Oscar Lewis had deemed a "culture of poverty" in a widely read 1966 Scientific American article had degenerated into an even more troubling "culture of dependency"—with culture understood as "values" and "beliefs" cleansed of their political economic correlates. As George W. Bush put it in his 1999 book, A Charge to Keep, "people became less interested in pulling themselves up by their bootstraps and more interested in pulling down a monthly government check. A culture of dependency was born" (1999:229–230). And although Clinton—whose "charge" on welfare was happily kept by his successor—blamed an antiquated welfare system for "trapping" recipients in a culture not of their own choosing, when discussing problems of poverty he also implicated a "cycle of dependency that keeps dragging people down."

In these quasi-anthropological terms, welfare state retrenchment found its powerful poetics. Indeed, when Clinton signed into law the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), which would establish lifetime limits, work requirements, and a number of conditions concerning both out-of-wedlock and teen parenting, he successfully performed a profound act of government retrenchment cast as moral cure: if poor people are afflicted with dependence, even the most menial and lowest paying "work opportunity" would provide a much needed dose of "personal responsibility." Accordingly, before putting pen to paper, President Clinton turned to the former welfare recipients beside him—who did much to authenticate his morality play—and commented, "They, too, have worked their way from welfare to independence and we're honored to have them here."

Nancy Fraser and Linda Gordon (1994) observe that American debates about poverty have long been framed in the terms of "dependency." Drawing on Raymond Williams's (1983) insight that particular keywords become focal points in political contests, and abiding by Foucault's genealogical method, Fraser and Gordon trace "dependency" across economic, socio-legal, political, and moral registers. As they "contextualize discursive shifts in relation to broad institutional and socio-structural shifts" (1994:311), Fraser and Gordon find that in post-industrial society, all adult "dependency"—save perhaps the economic dependence of a new wave of upper-middle-class housewives on their wage earning husbands—has been swathed in the rhetorical garb of individual pathology and moral failing.

Fraser and Gordon further argue that the discursive development of "dependency" has involved over-determined figures they call icons, which "condense multiple and often contradictory meanings" (1994:311). More pointedly, Fraser and Gordon note that icons dissimulate the political economic bases of social problems by personifying them. For instance, the iconic figure of the welfare dependent—itself a composite of other socially abhorrent historical figures—typifies deep and persistent cultural anxieties about race, gender, and citizenship while appearing simply a token of a naturally existing type. Accordingly, icons of dependency quite literally stand for the social contract gone awry (ibid.). Providing the rhetorical support for powerful political agendas, such as the one formally codified in the Rose Garden that August morning, icons buttress what I call policies of personhood—that is, policies that appear to respond to (rather than imagine or produce) particular types of people.

Policies of personhood are not just dramatized on grand, national stages, directed by presidential players with far-reaching plots in mind. As political scientist Michael Lipsky (1980) has cogently argued, policy is commonly made on the ground by "street-level bureaucrats"—teachers, police officers, social workers, and others charged with implementing policy mandates and therefore determining their efficacy. This chapter demonstrates how a diverse group of social service professionals builds icons and sustains policies of personhood through their everyday rhetorical practices. So while Fraser and Gordon are interested in doxa— the commonsense beliefs that escape the analytical scrutiny of those who feel they are merely an audience to political spectacles—this chapter focuses on the practices and beliefs of those most intricately involved in policy and person making (cf. Douglas and Ney 1998).

Notably, this focus requires a kind of analysis not readily afforded by the Foucaultian genealogy that Fraser and Gordon adopt and adapt. While a genealogy does the invaluable work of helping us to understand "broad discursive shifts"—as Fraser and Gordon do so well—it does much less to elucidate the everyday semiotic processes involved in the establishment and sustenance of powerful iconic figures. Indeed, if the ambitious analyses that Foucault inspired help us identify kinship patterns that connect our current-day icons ("welfare queens") to their equally troubling ancestors ("the pauper," "the native," "the slave"), we are nonetheless left with a critical question: What are the everyday ways of speaking and interacting that sustain the discourses and icons of dependency? And why might the very same people who express outrage at the sexism and racism of welfare reform discourse, or are themselves the subjects of it, engage closely related story lines, especially ones that involve the feminized and racialized themes of dependency?

To answer these questions, this chapter calls upon another analyst who specifically attended to the powers of the icon. In laying out his tripartite theory of the sign, American Pragmatist philosopher and father of semiotics Charles S. Peirce defined the icon as that which gains its significance in resemblance to its object. Iconic signs differ from their indexical brethren, which gain their meaning in a contiguous relation to their object (as in the case of smoke and fire) and also from symbols, which have an arbitrary (that is, conventional) relationship with that which they represent. However, the highly contingent and conventional nature of icons— as signs of semblance—was not lost on Peirce, who argued that since anything may resemble anything else, iconic signs are necessarily "motivated." In other words, icons are the product of the analogic practices of language users as they selectively establish relationships of likeness (Peirce 1955). Icons, then, gain their meaning not because they naturally resemble some unmediated thing in the world but instead because a community of speakers collectively designates that one kind of thing is like and therefore can come to stand for another. Drawing on the conversations of social service professionals and clients at Fresh Beginnings, as they work to establish and sustain program policy during troubling institutional times, this chapter illustrates the "motivated" processes by which icons come to realize their powerful political effects.

The policy stage in focus here is a daylong retreat in which a range of program participants—from administrators and clinical supervisors to therapists and case managers—work together to rebuild the Fresh Beginnings program, which had recently suffered a series of institutional blows and troubles. While we witness professionals discussing and sometimes debating the program mission, organizational structure, staff communication, and even interagency transportation, we will see that it is not until they reconstruct an iconic image of the Fresh Beginnings client that they are able to restructure the program.

Considering the timing of the event, only two and a half years after that fateful day in the White House Rose Garden, perhaps it is no surprise that the image the retreat participants built of the client highlights her dependency— both economic and chemical. And although the icon at Fresh Beginnings, like her counterpart in the Rose Garden, certainly functioned to redirect analytical energy from political and institutional analyses to moral and psychological evaluations, the point here is not to draw a simple parallel. Rather, I argue that the linguistic exchanges between retreat participants were motivated in two related senses. Primarily, and most obviously, professionals were desperately intent to (re)establish a strong foundation for their faltering program, and, for reasons elaborated below, they used a particular image of the client as an institutional support. However, Fresh Beginnings professionals did not simply borrow the dominant discourse of dependency, wholesale, nor adopt already established icons of dependency. Instead, through their extended and often arduous linguistic exchanges, retreat participants interactively established relations of likeness—work that was, in the Peircean sense, motivated. Indeed, it was largely through their semiotic labor that Fresh Beginnings professionals were able to forge an icon of dependency on which they themselves could depend.

Missions of Structure

It is a damp, heavy morning in March 1999. Affiliates of the Fresh Beginnings program—from agency case managers and program administrators to the newly hired therapist and her clinical supervisors—are climbing a narrow staircase to a stuffy second-story room on Cliff Street. The smell of stale Folgers and recently copied paper fills the two small adjoining rooms that, along with a dingy and rarely working bathroom, comprise the "administrative side" of the building. Usually it is here where supervisors tackle their paperwork, place important phone calls to other Homeless Family Consortium professionals, or conduct weekly meetings with child care staff who cajole, cuddle, and chase homeless children throughout the more expansive space of the affiliated "Kiddie Care" center downstairs.

The gathering staff, most of whom have commuted to Cliff Street from other HFC agency sites, peer into the smaller of the two upstairs rooms. Crammed with donated stuffed animals and other ragtag playthings, the cramped space has most recently served as a venue for "child therapy" as well as the after-school program run by Fresh Beginnings' two family therapists (Ella and Joe). Indeed, both upstairs rooms have taken on rotating purposes over the three and a half years of Fresh Beginnings' institutional life. Administrators' desks accommodate stacks of therapeutic pamphlets and giant teddy bears; child therapy sessions regularly relocate to the swing-set out back to allow space for an impromptu meeting of administrators in crisis.

This eclectic and sometimes chaotic environment stands in marked contrast to the cloistered therapy rooms on the other side of the building. Mirror-like, another set of stairs leads Fresh Beginnings clients to the L-shaped "group room" graced with cushy couches and pastel colored tissue boxes, to the chemical dependency (CD) therapists' office where individual sessions proceed behind a carefully sealed door, and to a relatively large bathroom where urine is "dropped" for screening. This architectural dichotomy is clinched by the lack of a direct passageway from the therapeutic to the administrative side of the building, leaving institutional travelers to cut through the first floor Kiddie Care Center, often amid the protests of its already overwhelmed staff.

Today, however, tired footsteps land only on one set of the Cliff Street stairs. Outdated FAX machines and desktop computers have been crammed into corners to make room for three long fold-out tables arranged in a giant "U" formation. Still, there is not enough space at the table for everyone, so latecomers drag folding chairs from across the hall and settle around the perimeter of the room, creating a nest-like effect. Warm greetings sporadically interrupt the steady murmur of packed-in neighbors who express muted incredulity about the lack of parking on Cliff Street, a largely student-populated, residential area in which the Fresh Beginnings program and its people cannot help but stand out conspicuously. Unread program documents are used as fans and eyes dart around, perhaps planning escape routes through the maze of human and metal chair legs for bathroom and cigarette breaks to come.

We have been called on this day to gather for a "retreat," a rosy label for a day-long meeting of official stock taking and strategic program planning. The timing of the retreat is no accident. After a bumpy three and a half years of institutional life, Fresh Beginnings has now found itself in a state of upheaval, suffering the exodus of the entire disgruntled staff at the child care center downstairs, the loss of two child and family therapists, and the forced resignation of the sole remaining CD therapist, Laura. Widely disliked by HFC staff, but adored by many of those she treated, Laura was followed by all but two of the clients, leaving a program that was designed to accommodate ten to twelve families with a record low census.

By special invitation, the two remaining clients will join the group today for a designated period, causing quiet discomfort among some of the professionals present. In response to carefully posed suggestions that clients are not well equipped to participate in administrative labor, Marne, the talented but embattled director of the HFC collaborative and the convener of the retreat, has cast her invitation as a sign of Fresh Beginnings' continued dedication to "consumer participation." In the program's start-up funding application to the Office of Housing and Urban Development, administrators emphasized their progressive dedication to "participant involvement in [HFC] decision-making" and "shared responsibility for program success." Yet despite the powerful rhetorical resonance of "responsible involvement," establishing mechanisms for such participation had proved both challenging and controversial in the past, rendering Marne's invitation a loaded gesture.

The range of invited participants was indeed intended to reflect—and therefore effect—inclusive collaboration. However, the negativity in the air is at least partially attributable to the fact that these sorts of events, which seemingly offer everyone an opportunity to contribute, tend to take on a rather superficial quality. In the face of those who dole out needed services from housing to therapy, it is unlikely that clients, for instance, would be inclined to complain as vociferously or pointedly as they otherwise might. Line workers' comments, too, are carefully edited as their bosses either nod emphatically or remain expressionless in a telling non-response. And though administrators generally acknowledge and sometimes work to sort through clients' and line workers' comments and contributions, all are aware that decisions are ultimately made by Marne, Leif (the commanding director of HELPNET—HFC's largest and most comprehensive service provider), and Charles (the lead man at Hope Health). (Marne reports to Leif and is, in theory, equally responsible to Charles; she also serves as the perennial fall guy as she relays upper-level decisions to HFC staff members with the not-always-accurate, and often rankling, pronoun "we".) Today few in the room seem to buy Marne's suggestion that the retreat will be a marketplace of ideas, each with potentially valuable purchasing power.

(Continues...)

Excerpted from Scripting Addictionby E. Summerson Carr Copyright © 2011 by Princeton University Press. Excerpted by permission of PRINCETON UNIVERSITY PRESS. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Edition details

• Publisher: Princeton University Press
• Publication date: 2010
• ISBN 10: 0691144508
• ISBN 13: 9780691144504
• Binding: Paperback
• Language: English
• Number of pages: 336