Addiction Trajectories (Experimental Futures) - Softcover

Softcover

ISBN 10: 0822353644 ISBN 13: 9780822353645

Publisher: Duke University Press, 2013

Synopsis

Bringing anthropological perspectives to bear on addiction, the contributors to this important collection highlight the contingency of addiction as a category of human knowledge and experience. Based on ethnographic research conducted in sites from alcohol treatment clinics in Russia to Pentecostal addiction ministries in Puerto Rico, the essays are linked by the contributors' attention to the dynamics—including the cultural, scientific, legal, religious, personal, and social—that shape the meaning of "addiction" in particular settings. They examine how it is understood and experienced among professionals working in the criminal justice system of a rural West Virginia community; Hispano residents of New Mexico's Espanola Valley, where the rate of heroin overdose is among the highest in the United States; homeless women participating in an outpatient addiction therapy program in the Midwest; machine-gaming addicts in Las Vegas, and many others. The collection's editors suggest "addiction trajectories" as a useful rubric for analyzing the changing meanings of addiction across time, place, institutions, and individual lives. Pursuing three primary trajectories, the contributors show how addiction comes into being as an object of knowledge, a site of therapeutic intervention, and a source of subjective experience.

Contributors. Nancy D. Campbell, E. Summerson Carr, Angela Garcia, William Garriott, Helena Hansen, Anne M. Lovell, Emily Martin, Todd Meyers, Eugene Raikhel, A. Jamie Saris, Natasha Dow Schüll

About this title

About the Author

Eugene Raikhel is Assistant Professor of Comparative Human Development at the University of Chicago.

William Garriott is Assistant Professor of Justice Studies at James Madison University. He is the author of Policing Methamphetamine: Narcopolitics in Rural America.

Excerpt. © Reprinted by permission. All rights reserved.

ADDICTION TRAJECTORIES

By EUGENE RAIKHEL, WILLIAM GARRIOTT

Duke University Press

Copyright © 2013 Duke University Press
All rights reserved.

ISBN: 978-0-8223-5364-5

Contents

Acknowledgments............................................................
vii
INTRODUCTION Tracing New Paths in the Anthropology of Addiction EUGENE 
RAIKHEL AND WILLIAM GARRIOTT...............................................
1
ONE The Elegiac Addict ANGELA GARCIA......................................
36
TWO Balancing Acts: Gambling-Machine Addiction and the Double Bind of 
Therapeutics NATASHA DOW SCHULL...........................................
61
THREE A Few Ways to Become Unreasonable: Pharmacotherapy Inside and 
Outside the Clinic TODD MEYERS............................................
88
FOUR Pharmaceutical Evangelism and Spiritual Capital: An American Tale of 
Two Communities of Addicted Selves HELENA HANSEN..........................
108
FIVE Elusive Travelers: Russian Narcology, Transnational Toxicomanias, and 
the Great French Ecological Experiment ANNE M. LOVELL.....................
126
SIX Signs of Sobriety: Rescripting American Addiction Counseling E. 
SUMMERSON CARR.............................................................
160
SEVEN Placebos or Prostheses for the Will? Trajectories of Alcoholism 
Treatment in Russia EUGENE RAIKHEL........................................
188
EIGHT "You Can Always Tell Who's Using Meth": Methamphetamine Addiction 
and the Semiotics of Criminal Difference WILLIAM GARRIOTT.................
213
NINE "Why Can't They Stop?" A Highly Public Misunderstanding of Science 
NANCY D. CAMPBELL..........................................................
238
TEN Committed to Will: What's at Stake for Anthropology in Addiction A. 
JAMIE SARIS................................................................
263
AFTERWORD Following Addiction Trajectories EMILY MARTIN...................
284
References.................................................................
293
Contributors...............................................................
327
Index......................................................................
329

Excerpt

CHAPTER 1

ANGELA GARCIA

THE ELEGIAC ADDICT

Eternal Return

On the cusp of her thirtieth birthday, Alma Gallegos was discoveredlying in the parking lot near the emergency-room entranceat Española Hospital. Like many patients who present atthis particular ER, Alma was anonymously dumped by acquaintanceswho likely feared she might die or was already dead. Infact, Alma was close to death: her breath was shallow; her heartrate barely discernible at six beats per minute; and, despite theintense summer heat, her skin cold to the touch. Upon quick inspectionof her swollen limbs, the attending physician determinedthat Alma had overdosed on heroin, and she was treatedwith naloxone, an opioid antidote that, if administered in time,revives the body's central nervous and respiratory systems. Alma'svital signs were soon stabilized, and she remained in thehospital until the local drug court mandated that she be transferredto the very drug treatment facility from which she had recentlydischarged herself.

Four days after her overdose, Alma emerged from the facility'swomen's dormitory. With one hand against the wall for support,she shuffled unsteadily down a narrow hallway and entered herdrug counselor's office with a groan. Having privately sufferedthrough the initial torments of heroin withdrawal, it was now expectedthat she begin putting addictive experience into a socialand linguistic frame—an exercise central to the clinic's therapeuticprocess. Alma pulled at her hair uncomfortably; her body twitched,and pebbles of sweat collected on her brow. For several minutes, she lookedaround the small, windowless office and stared blankly at the counselor.Finally, she asked in the Hispano manner (i.e., more statement than question):"Yo estuve aquí una vez, no?" (I've been here before, haven't I?)

Indeed, it was Alma's second admission to the detoxification clinic in ayear and her sixth admission to a drug recovery program in just five years.Addicted to heroin for half of her life, Alma's affective world—from herembodied pains to her cravings and the quietude she experiences during aheroin high—were as familiar to her as the institutions intermittentlycharged with apprehending or caring for her. It was a familiarity achievedthrough certain recurring personal and institutional fractures, indexed bylong stretches of heroin use, arrest, mandatory treatment, and an eventualand ongoing return to heroin use, arrest, and treatment.

In clinical parlance, Alma's return to detox was a "relapse." Such adetermination was in accordance with the logic of contemporary publichealth and addiction medicine, which understands and treats drug addictionprimarily as a "chronic health problem, not a moral failing or a socialproblem" (McLellan et al. 2000). But Alma understood her presence at theclinic less as a "relapse," which connotes a period of remission, than as a"return"—a return to living "once more and innumerable times more"(Nietzsche 1974: 274) this particular aspect of Hispano life; these wearylimbs, this room, this familiar and anticipated question now posed to herby the drug counselor: What happened?

For several moments, Alma pulled at her hair and let the questionlinger. Then she told the counselor that nothing had happened. "Es que loque tengo no termina" (It's just that what I have has no end), she said. Yetalmost two years later, Alma was rushed to the same hospital ER, whereshe was pronounced dead after overdosing on heroin.

This chapter considers heroin addiction and overdose in northern NewMexico's Española Valley as a vexing condition marked by the impossibilityand the inevitability of an end. It reflects on observations and interviewsI conducted with Alma between 2004 and 2006 and gives a sense ofher struggle to reconcile this condition's inherent contradictions. Amongits primary concerns are how recurring forms of personal and institutionalexperience configure the struggle—as well as the ways Alma wouldcome to apprehend her world, her addiction, and, ultimately, the horizonof her future. The stress here is on the political and psychoanalytic, and Ilink local modalities of emotion, perception, and subjectivity—writ largeas heroin addiction—to certain historical refrains. My goal is to explorehow ongoing political, economic, cultural, and biological forces constitutedAlma's life—and her determination that it was not worth living.

The Melancholic Subject

The Española Valley is a rural network of poor, Spanish-speaking villagesat the center of a triangle whose points are the tourist meccas of Santa Feand Taos and the scientific center of Los Alamos. It encompasses the site ofthe first Spanish colonial settlement in the U.S. Southwest (where presentdayEspañola resides) and is the site of centuries of colonial exploitation,resistance, and change. Since the 1990s, the region has had the highest rateof heroin overdose and heroin-induced death in the country. In a populationof just over thirty thousand residents, nearly seventy people died fromheroin overdose in one recent eighteen-month period—which is to saythat nearly everybody knows somebody addicted to heroin or who has diedbecause of it. The social and emotional wake of these deaths reverberateswith the still tender wounds of recent history, such as the ongoing Hispanodispossession from, and longing for, ancestral lands and the consequentfragmentation of social order and intimate life. These constitute a recurringexperience of loss that, if not directly assimilable, is nevertheless familiarin the sense of the very structure of recurrence and in the sense ofthe close connection this structure has to forms of loss: the loss of a tradition,a village, a daughter, a friend. My concern here is about these experiencesof loss and memories of it, how intersecting forms of history come tobear on the present, and how heroin use—and overdose in particular—exposesthe painful recognition that the future has been swallowed up bythe past.

In "Mourning and Melancholia," Freud (1989 [1917]: 586) defines mourningas "the reaction to the loss of a loved person, or to the loss of someabstraction." It designates a psychic process to loss where the mourner isable to work gradually through grief, reaching a definite conclusion wherebythe lost object or ideal is essentially let go and the mourner able to moveon. Melancholy, by contrast, designates a kind of mourning without end. Itentails an incorporation of the lost person or ideal as a means to keep italive. Regarding its somatic features, Freud describes the sleeplessness ofthe melancholic, suggesting that it attests to the steadfastness of the condition."The complex of melancholia," he writes, "behaves like an openwound" (S. Freud 1989 [1917]: 589).

In Freud's conception, the melancholic's sustained devotion to what islost is pathological. He warns that the intensity of the "self-tormenting"condition can culminate in the melancholic's demise—most notably, viasuicide (S. Freud 1989 [1917]: 588). More recent efforts to examine Freud'sexploration of melancholia have been critical of his understanding of it aspathology and have offered important modifications to his theory—particularlythe productive possibilities of melancholy in terms of subjectivity,art, and politics (see Butler 2004; Cheng 2001; Eng and Kazanjian2003; Muñoz 1997). But here I want to pursue Freud's original suggestionregarding the danger to life melancholy may pose. In The Ego and the Id,Freud (1960 [1923]: 28) writes that melancholy possesses the power toshape the subject in a fundamental way—indeed, to determine the subject'svery fate. The unrelenting nature of melancholy transforms the subjectinto one who mourns—transforms her, first and foremost, into amelancholic subject. But what if we conceive the subject of melancholynot simply as the one who suffers, but as the recurring historical refrainsthrough which sentiments of "endless" suffering arise? How do we attendto these wounds?

The "melancholic subject" here is Alma and the structures in which herfatal overdose took root. And it refers to the all-too-familiar experiencesof loss, articulated now as addiction, which have been shaped in part bythe kinds of attachments that the logic of chronicity assumes. The recentwork of anthropologists shows us how medical and technical forms ofknowledge and intervention shape the experience and course of illnessand more broadly affect subjectivity (Biehl 2005; Cohen 1999; Petryna2002; Scheper-Hughes 2000; Young 1995). In the context of addiction,chronicity as knowledge and practice has become the ground for a newform of melancholic subjectivity that recasts a longstanding ethos ofHispano suffering into a succession of recurring institutional interactions.As Michael Fischer (2003: 51) describes, "We are embedded, ethically,as well as existentially and materially, in technologies and technologicalprostheses," and these take us into new models of ethics in which"our older moral traditions have little guidance or experience to offer."In the context of emerging technologies, he aptly describes us as being"thrown ... to new forms of social life" (Fischer 2003: 51; emphasis added).But here, I want to suggest that the Hispano ethos of suffering is a socialreferent for addiction's recent biomedical turn, and the disparate technologiesin which this turn is embedded (drug-treatment centers, researchconferences, Narcotics Anonymous meetings, and so on) deepenthis ethos of suffering in unexpected, even dangerous, ways. In the contextof its preceding Hispano forms, I examine how these technologiesnot so much throw us but bury us beneath the weight of that which doesnot end.

A Work of Mourning

Anthropology has shown how following the life history of a single personcan illuminate the complex intimate and structural relations that come toconstitute a life, a community, and a social world (Biehl 2005; Das 2000;Desjarlais 2003; Pandolfo 1998). In following the plot of Alma's life, I alsoengage in this form of inquiry. I do so while recognizing that there aremany elements of Alma's story that I do not know and other elements thatcould be told in the voice of Bernadette, Yvette, Johnny, Marcus, or any ofthe many other subjects I followed during the course of my research. Theywere all caught within the same cycle of trying to live their lives withoutheroin and surrendering their lives to it. I thus present Alma as embodyinga condition that is more than hers alone.

While there are certain refrains between Alma's experience and theexperience of Hispanos more broadly, one of my commitments here is toconvey Alma as she appeared to me—generous, reflective, and deeplyengaged in trying to find a way to live. In relating Alma's life, and in tryingto reckon for her death, this chapter constitutes a kind of "work of mourning,"but in terms that differ from recent anthropological works on violenceand subjectivity, which examine discursive practices that seek tomake possible the repair of injury and of the everyday (see Das 2000;Seremetakis 1991). Instead, this chapter constitutes a work of mourning inanother tradition: the Hispano tradition, which commemorates the singularityof death while insisting on the inevitable repetition of it. It is atradition that involves the creation of memorials called descansos (restingplaces) that are publicly placed at or near the site of death. The descansodoes not seek to reinhabit the site of loss or repair the everyday; rather, itinsists on death's essential relationship to life. Over the years, heroin-relateddescansos have gathered on the Hispano landscape. Frequentlyadorned with the used syringes that contained the lethal dose of drug, theyhighlight just how enmeshed heroin has become in physical space andeveryday life, and they pose the question of whether and how "mourningas repair" is possible or even desired in the face of unrelenting loss. Risingalong the edges of dirt roads and scattered among the valley's juniper-dottedhills, the undisturbed presence of the descansos constitutes a kindof ethical commitment to that which was lost. They keep vigil over it; theycoexist.

One day, while we were sitting together in my parked car in front of theEspañola Public Library, a certain memory flashed up for Alma, urgentand unannounced. It was a cold afternoon, already dark despite the earlyhour. I turned on the car's ignition and was ready to return Alma to thehalfway house in which she resided following thirty days of heroin detoxification.To my surprise, Alma grabbed my hand and told me to wait; shewasn't ready to go back. For a few moments, we stared quietly at thelibrary's iron-barred windows, our breath visible in the chilly air. Almabroke the silence and told me that her older sister Ana, whom she hadnever mentioned to me before, loved to read. Ana had been killed by adrunk driver four years earlier. She had been on her way to work, Almarecalled, driving along the winding two-lane highway that connects Españolato Chimayó. Days before her death, Ana had called Alma to sharethe news that she was pregnant.

Following local custom, the Gallegos family put up a handmade descansoin the very spot that Ana was killed. Alma told me that afternoon infront of the library that it still marked the spot of her sister's death andasked if I'd seen it. She described the plastic yellow flowers and fadingfamily portrait that adorned Ana's wooden cross. I told Alma that I knewthe descanso and offered to drive her there. Alma shook her head no andadded that for years she had to turn her head away every time she passedthe cross during the trip to Chimayó to meet her dealer. She confessedthat she still turned her head away but was able to conjure the image of thedescanso in her mind. She said, "Ahí está, mirándome" (There it is, lookingat me).

In his examination of the English elegy, Peter Sacks (1985) notes thatthe traditional forms and figures of the genre relate to an experience ofloss and the search for consolation. The passage from grief to consolationis often presented in the form of repetition—that is, through the recurrenceof certain words and refrains. Take, for example, Theocratis's "FirstIdyl," the poem said to have initiated the elegiac genre: "I weep for Adonis;lovely Adonis is dead. Dead is lovely Adonis; the Loves join in weeping"(quoted in Sacks 1985: 23). According to Sacks, the elegy's repetitive structurefunctions to separate the living from the dead and forces the bereavedto accept a loss that he might otherwise refuse. He goes on to suggest thatthe reiterative structure of elegy mirrors one of the psychological responsesto trauma, whereby the psyche repeats the traumatic event toretroactively alleviate the initial shock it caused. In this way, the repetitioncreates a rhythm of lament that allows grief to be simultaneously conjuredforth and laid to rest. But what if the structure of repetition creates not aworking through grief but the intensification of it? What if the demarcationbetween the living and dead instead reinforces the shock of loss andrepresents a refusal to "properly mourn"? How might the structure ofrepetition become a constitutive force for a kind of mourning that doesnot end?

Alma's past returned to her in feeling and image, inducing a neverendingtension—not a resolution—between today and yesterday, betweenthe dead and the living. Like the descanso that marks her sister's death, theelegiac character of Alma's narrative offers a continuous double-take onthinking about the relationship between history, loss, and the present:what is lost is what remains. In Alma's words, it is "sin fin" (without end),forging the patterns of her experience.

(Continues...)

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Edition details

• Publisher: Duke University Press
• Publication date: 2013
• Language: English
• ISBN 10: 0822353644
• ISBN 13: 9780822353645
• Binding: Paperback
• Number of pages: 346
• Editor: Raikhel