Addiction Trajectories

Addiction Trajectories

by Eugene Raikhel (Editor)

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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.

. 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

Product Details

ISBN-13: 9780822353645
Publisher: Duke University Press Books
Publication date: 04/18/2013
Series: Experimental Futures Series
Edition description: New Edition
Pages: 348
Product dimensions: 6.10(w) x 9.30(h) x 0.90(d)

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.

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ISBN: 978-0-8223-5364-5





Eternal Return

On the cusp of her thirtieth birthday, Alma Gallegos was discovered lying in the parking lot near the emergency-room entrance at Española Hospital. Like many patients who present at this particular ER, Alma was anonymously dumped by acquaintances who likely feared she might die or was already dead. In fact, Alma was close to death: her breath was shallow; her heart rate barely discernible at six beats per minute; and, despite the intense summer heat, her skin cold to the touch. Upon quick inspection of her swollen limbs, the attending physician determined that Alma had overdosed on heroin, and she was treated with naloxone, an opioid antidote that, if administered in time, revives the body's central nervous and respiratory systems. Alma's vital signs were soon stabilized, and she remained in the hospital until the local drug court mandated that she be transferred to the very drug treatment facility from which she had recently discharged herself.

Four days after her overdose, Alma emerged from the facility's women's dormitory. With one hand against the wall for support, she shuffled unsteadily down a narrow hallway and entered her drug counselor's office with a groan. Having privately suffered through the initial torments of heroin withdrawal, it was now expected that she begin putting addictive experience into a social and linguistic frame—an exercise central to the clinic's therapeutic process. Alma pulled at her hair uncomfortably; her body twitched, and pebbles of sweat collected on her brow. For several minutes, she looked around 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 a year 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 her embodied pains to her cravings and the quietude she experiences during a heroin high—were as familiar to her as the institutions intermittently charged with apprehending or caring for her. It was a familiarity achieved through certain recurring personal and institutional fractures, indexed by long stretches of heroin use, arrest, mandatory treatment, and an eventual and ongoing return to heroin use, arrest, and treatment.

In clinical parlance, Alma's return to detox was a "relapse." Such a determination was in accordance with the logic of contemporary public health and addiction medicine, which understands and treats drug addiction primarily as a "chronic health problem, not a moral failing or a social problem" (McLellan et al. 2000). But Alma understood her presence at the clinic 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 weary limbs, this room, this familiar and anticipated question now posed to her by the drug counselor: What happened?

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

This chapter considers heroin addiction and overdose in northern New Mexico's Española Valley as a vexing condition marked by the impossibility and the inevitability of an end. It reflects on observations and interviews I conducted with Alma between 2004 and 2006 and gives a sense of her struggle to reconcile this condition's inherent contradictions. Among its primary concerns are how recurring forms of personal and institutional experience configure the struggle—as well as the ways Alma would come to apprehend her world, her addiction, and, ultimately, the horizon of her future. The stress here is on the political and psychoanalytic, and I link local modalities of emotion, perception, and subjectivity—writ large as heroin addiction—to certain historical refrains. My goal is to explore how ongoing political, economic, cultural, and biological forces constituted Alma'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 villages at the center of a triangle whose points are the tourist meccas of Santa Fe and Taos and the scientific center of Los Alamos. It encompasses the site of the first Spanish colonial settlement in the U.S. Southwest (where presentday Española resides) and is the site of centuries of colonial exploitation, resistance, and change. Since the 1990s, the region has had the highest rate of heroin overdose and heroin-induced death in the country. In a population of just over thirty thousand residents, nearly seventy people died from heroin overdose in one recent eighteen-month period—which is to say that nearly everybody knows somebody addicted to heroin or who has died because of it. The social and emotional wake of these deaths reverberates with the still tender wounds of recent history, such as the ongoing Hispano dispossession from, and longing for, ancestral lands and the consequent fragmentation of social order and intimate life. These constitute a recurring experience of loss that, if not directly assimilable, is nevertheless familiar in the sense of the very structure of recurrence and in the sense of the 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 experiences of loss and memories of it, how intersecting forms of history come to bear on the present, and how heroin use—and overdose in particular—exposes the painful recognition that the future has been swallowed up by the past.

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

In Freud's conception, the melancholic's sustained devotion to what is lost is pathological. He warns that the intensity of the "self-tormenting" condition can culminate in the melancholic's demise—most notably, via suicide (S. Freud 1989 [1917]: 588). More recent efforts to examine Freud's exploration of melancholia have been critical of his understanding of it as pathology and have offered important modifications to his theory—particularly the productive possibilities of melancholy in terms of subjectivity, art, and politics (see Butler 2004; Cheng 2001; Eng and Kazanjian 2003; Muñoz 1997). But here I want to pursue Freud's original suggestion regarding the danger to life melancholy may pose. In The Ego and the Id, Freud (1960 [1923]: 28) writes that melancholy possesses the power to shape the subject in a fundamental way—indeed, to determine the subject's very fate. The unrelenting nature of melancholy transforms the subject into one who mourns—transforms her, first and foremost, into a melancholic subject. But what if we conceive the subject of melancholy not simply as the one who suffers, but as the recurring historical refrains through which sentiments of "endless" suffering arise? How do we attend to these wounds?

The "melancholic subject" here is Alma and the structures in which her fatal overdose took root. And it refers to the all-too-familiar experiences of loss, articulated now as addiction, which have been shaped in part by the kinds of attachments that the logic of chronicity assumes. The recent work of anthropologists shows us how medical and technical forms of knowledge and intervention shape the experience and course of illness and more broadly affect subjectivity (Biehl 2005; Cohen 1999; Petryna 2002; Scheper-Hughes 2000; Young 1995). In the context of addiction, chronicity as knowledge and practice has become the ground for a new form of melancholic subjectivity that recasts a longstanding ethos of Hispano 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 technological prostheses," 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 social referent for addiction's recent biomedical turn, and the disparate technologies in which this turn is embedded (drug-treatment centers, research conferences, Narcotics Anonymous meetings, and so on) deepen this ethos of suffering in unexpected, even dangerous, ways. In the context of its preceding Hispano forms, I examine how these technologies not so much throw us but bury us beneath the weight of that which does not end.

A Work of Mourning

Anthropology has shown how following the life history of a single person can illuminate the complex intimate and structural relations that come to constitute 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 also engage in this form of inquiry. I do so while recognizing that there are many elements of Alma's story that I do not know and other elements that could be told in the voice of Bernadette, Yvette, Johnny, Marcus, or any of the many other subjects I followed during the course of my research. They were all caught within the same cycle of trying to live their lives without heroin and surrendering their lives to it. I thus present Alma as embodying a condition that is more than hers alone.

While there are certain refrains between Alma's experience and the experience of Hispanos more broadly, one of my commitments here is to convey Alma as she appeared to me—generous, reflective, and deeply engaged in trying to find a way to live. In relating Alma's life, and in trying to reckon for her death, this chapter constitutes a kind of "work of mourning," but in terms that differ from recent anthropological works on violence and subjectivity, which examine discursive practices that seek to make possible the repair of injury and of the everyday (see Das 2000; Seremetakis 1991). Instead, this chapter constitutes a work of mourning in another tradition: the Hispano tradition, which commemorates the singularity of death while insisting on the inevitable repetition of it. It is a tradition that involves the creation of memorials called descansos (resting places) that are publicly placed at or near the site of death. The descanso does not seek to reinhabit the site of loss or repair the everyday; rather, it insists on death's essential relationship to life. Over the years, heroin-related descansos have gathered on the Hispano landscape. Frequently adorned with the used syringes that contained the lethal dose of drug, they highlight just how enmeshed heroin has become in physical space and everyday life, and they pose the question of whether and how "mourning as repair" is possible or even desired in the face of unrelenting loss. Rising along the edges of dirt roads and scattered among the valley's juniper-dotted hills, the undisturbed presence of the descansos constitutes a kind of ethical commitment to that which was lost. They keep vigil over it; they coexist.

One day, while we were sitting together in my parked car in front of the Española Public Library, a certain memory flashed up for Alma, urgent and unannounced. It was a cold afternoon, already dark despite the early hour. I turned on the car's ignition and was ready to return Alma to the halfway house in which she resided following thirty days of heroin detoxification. To my surprise, Alma grabbed my hand and told me to wait; she wasn't ready to go back. For a few moments, we stared quietly at the library's iron-barred windows, our breath visible in the chilly air. Alma broke the silence and told me that her older sister Ana, whom she had never mentioned to me before, loved to read. Ana had been killed by a drunk driver four years earlier. She had been on her way to work, Alma recalled, driving along the winding two-lane highway that connects Española to Chimayó. Days before her death, Ana had called Alma to share the news that she was pregnant.

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

In his examination of the English elegy, Peter Sacks (1985) notes that the traditional forms and figures of the genre relate to an experience of loss and the search for consolation. The passage from grief to consolation is often presented in the form of repetition—that is, through the recurrence of certain words and refrains. Take, for example, Theocratis's "First Idyl," 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 structure functions to separate the living from the dead and forces the bereaved to accept a loss that he might otherwise refuse. He goes on to suggest that the reiterative structure of elegy mirrors one of the psychological responses to trauma, whereby the psyche repeats the traumatic event to retroactively alleviate the initial shock it caused. In this way, the repetition creates a rhythm of lament that allows grief to be simultaneously conjured forth and laid to rest. But what if the structure of repetition creates not a working through grief but the intensification of it? What if the demarcation between the living and dead instead reinforces the shock of loss and represents a refusal to "properly mourn"? How might the structure of repetition become a constitutive force for a kind of mourning that does not end?

Alma's past returned to her in feeling and image, inducing a neverending tension—not a resolution—between today and yesterday, between the dead and the living. Like the descanso that marks her sister's death, the elegiac character of Alma's narrative offers a continuous double-take on thinking 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.

Excerpted from ADDICTION TRAJECTORIES by EUGENE RAIKHEL. Copyright © 2013 by Duke University Press. Excerpted by permission of DUKE UNIVERSITY PRESS.
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Table of Contents

Acknowledgments vii

Introduction. Tracing New Paths in the Anthropology of Addiction / Eugene Raikhel and William Garriott 1

1. The Elegiac Addict / Angela Garcia 36

2. Balancing Acts: Gambling-Machine Addiction and the Double Bind of Therapeutics / Natasha Dow Schüll 61

3. A Few Ways to Become Unreasonable: Pharmacotherapy Inside and Outside the Clinic / Todd Meyers 88

4. Pharmaceutical Evangelism and Spiritual Capital: An American Tale of Two Communities of Addicted Selves / Helena Hansen 108

5. Elusive Travelers: Russian Narcology, Transnational Toxicomanias, and the Great French Ecological Experiment / Anne M. Lovell 126

6. Signs of Sobriety: Rescripting American Addiction Counseling / E. Summerson Carr 160

7. Placebos or Prostheses for the Will: Trajectories of Alcoholism Treatment in Russia / Eugene Raikhel 188

8. "You Can Always Tell Who's Using Meth": Methamphetamine Addiction and the Semiotics of Criminal Difference / William Garriott 213

9. "Why Can't They Stop?" A Highly Public Misunderstanding of Science / Nancy D. Campbell 238

10. 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

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