What are the life histories of Eugenia and Bernadette, and Lisa and Michele? What do these mother/daughter relationships tell us about how the experience of addiction inherited from one gener

The Pastoral Clinic

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The Pastoral Clinic a d d i c t i o n a n d d i s p o s s e s s i o n a l o n g t h e r i o g r a n d e

a n g e l a g a r c i a

u n i v e r s i t y o f c a l i f o r n i a p r e s s Berkeley Los Angeles London

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University of California Press Berkeley and Los Angeles, California

University of California Press, Ltd. London, En gland

© 2010 by Angela Garcia

Library of Congress Cataloging- in- Publication Data

Garcia, Angela, 1971– The pastoral clinic : addiction and dispossession

along the Rio Grande / Angela Garcia. p. cm.

Includes bibliographical references and index. isbn 978-0-520-25829-7 (cloth : alk. paper) — isbn 978-0-520-26208-9

(pbk. : alk. paper) 1. Heroin abuse—New Mexico. 2. Drug addicts—New Mexico.

I. Title.

hv5822.h4g37 2010 362.29'3092368078952—dc22

2010001811

Manufactured in the United States of America

19 18 17 16 15 14 13 12 11 10 10 9 8 7 6 5 4 3 2 1

This book is printed on Cascades Enviro 100, a 100% post consumer waste, recycled, de- inked fiber. FSC recycled certified and pro cessed chlorine free. It is acid free, Ecologo certified, and manufactured by BioGas energy.

Para Ruby y Lucía

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Memory aches, wherever it is touched.

Giorgios Seferis

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Contents

List of Illustrations xi

Acknowledgments xiii

Introduction 1

1. Graveyard 37

2. The Elegiac Addict 69

3. Blood Relative 111

4. Suicide as a Form of Life 150

5. Experiments with Care 183

Conclusion: A New Season 205

Notes 211

Bibliography 223

Index 237

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Illustrations

1. El río 8 2. Waiting room 48 3. Trinity 60 4. General store 83 5. Feeding the crops 103 6. Friday night 132 7. Española 138 8. Wall of prayers 169 9. Alone 176

10. La Joya 195

xi

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Acknowledgments

My deepest gratitude goes to the many women and men struggling with heroin addiction in the Española Valley who let me into their lives. It was an honor to be trusted with their stories. I thank my neighbors for teach- ing me what it is to be just that— a neighbor, generous of care. Although I give pseudonyms to those featured in the pages that follow, I want them to know that their lives have left an indelible imprint on my own. I so much wanted the woman I call “Alma” to be able to read this work. It is my hope that her story will one day help others.

I am indebted to the staff of Nuevo Día, especially the executive direc- tor, for allowing me to chronicle their work and for welcoming me as a staff member, researcher, and friend. I also thank the many health pro- fessionals, activists, and residents in the Española Valley who shared their thoughts and stories with me. Special thanks go to Luis Torres and High Country News Magazine for getting me on the path to writing.

This book grows out of research that I conducted for my Ph.D. disser- tation at Harvard University. I would like to thank my thesis chair, Arthur

xiii

Kleinman, for his scrupulous engagement with my work and for his confidence in this text. His advice to focus on what truly matters ulti- mately inspired me to return to New Mexico. Byron Good has been a trusted source of support on matters intellectual and practical, as well as a friend; my thanks go to him. I thank Kay Warren for her generous insight, for her support, and for being a true compañera. Also at Harvard, I would like to extend my deep appreciation to Michael Fischer, David Carrasco, and Mary- Jo DelVecchio Good. The following institutions made this research possible: the National Science Foundation, the Na- tional Academy of Sciences Ford Doctoral Dissertation Fellowship, the National Institutes of Mental Health NRSA Predoctoral Fellowship, a Harvard University Graduate Fellowship, and a Summer Research Fel- lowship for Health and Social Justice, School of Social Medicine, Har- vard University.

I owe a debt of gratitude to João Biehl for reading earlier drafts of this book and for his per sis tent reminder to stay close to the ethnography. It is a deceptively simple message that strengthened this work in impor- tant ways. I thank the University of California Press, especially its astute reviewers, for expressing confidence in this book and Sheila Berg for her skillful editing. I am especially grateful to Stan Holwitz for his enduring support and words of kindness. And I thank Stuart Bernstein for re- minding me that I am a writer.

I am also grateful to the following individuals for their crucial advice and support: Leo Chavez, Clara Han, Philippe Bourgois, Joe Dumit, William Maurer, Tom Boellstorff, Julia Elyachar, Michael Montoya, Keith Murphy, Eugene Raikel, William Garriott, Noelle Stout, Omar al- Dewachi, Hosam Aboul- Ela, Chris Dole, and the editors of and anony- mous reviewers for Cultural Anthropology. I began revising this work dur- ing my tenure as a President’s Postdoctoral Fellow at the University of California, Los Angeles; my thanks go to Carole Browner, Susan Sly- omovics, Jason Throop, Linda Garro, Allesandro Duranti, Chon Noriega, and Otto Santa Ana. I also owe special thanks to Lawrence Cohen and Nancy Scheper- Hughes, my mentors during my undergraduate years at UC Berkeley. It was their work that inspired me to pursue anthropology, and it inspires me still.

xiv a c k n o w l e d g m e n t s

Thank you to Jaime Santos, Tali Bray, and Michael Marco for support- ing me over the years and for making life such a plea sure.

I end by expressing my deepest gratitude to my family. Rubén Martínez supported me from the very beginning to the very end of this work. His insights, encouragement, patience, and editing skills are wo- ven into every page. Rubén made New Mexico a place that I could call home again, and for that I am especially grateful. Every day I thank my daughters, Ruby and Lucía, for their wonderful appearance in my world and for making every day such a joy. And the Garcia women— especially my mother, Wilma, and my sister, Kristina, who were the first to teach me what it means to care. And, finally, my gratitude to Bear and Chino.

a c k n o w l e d g m e n t s xv

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Introduction

a m e r i c a n p a s t o r a l

The clinic is a house: small, brown, made of straw bale and mud plaster. It sits at the end of an unpaved road ten miles from the nearest town. Fifteen acres of dirt dotted with desert sage surround it and, here and there, clusters of cottonwood trees, dilapidated outbuildings, rusted metal chairs. A netless basketball hoop leans precariously. It looks as though it is about to collapse with the next gust of strong, summer wind. We watch it from our perch by a coffee- can ashtray and wonder when it will finally fall.

John smokes a cigarette and stares blankly at the cloudless blue sky. Though it’s 85 degrees, Lupita’s thin body is wrapped in layers of sweat- shirts and blankets. She nods off in her chair, her head rhythmically

1

falling and rising, falling and rising. Bernadette complains that her legs hurt, feel knotted and twisted up. “How much longer,” she asks me, “till the next dose?”

The three are heroin addicts living at a drug detoxification clinic in northern New Mexico’s Española Valley.1 Since the early 1990s the Es- pañola Valley has had the highest per capita rate of heroin- induced deaths in the United States. In a region of just over 30,000 residents, nearly 70 people died from heroin overdose in little over a year— which is to say that within this close network of rural towns and villages, everybody knows somebody who is addicted to heroin or has died because of it.

John, Bernadette, and Lupita are in varying stages of heroin detox, a month- long pro cess that uses medications to ease the pain of withdrawal. Like the majority of patients at the clinic, they are court appointed— or sentenced— to detoxification, the first official step in a longer pro cess of drug recovery and, in their cases, punitive rulings.2 This is not the first time they have undergone treatment, or sentencing, for their heroin addiction.

I had recently been hired to work at the clinic as a detoxification attendant— a job I took as a means to get closer to subjects in my area of ethnographic study. Like all the other attendants, I received no formal training for the position, although I was required to take an examination that certified my ability to properly distribute prescription medications used in the clinic, especially the narcotic- based relajantes (relaxants) that many patients used on the “streets.” At the clinic, use of these medica- tions was “legitimate,” and patients asked for them with desperation. They were unable, it seemed, to adjust their bodies’ addictive demands to the clinical indications of las pildoras—capsules such as Darvon and Librium— which on the street are commonly crushed and injected like heroin.

On my own I quickly learned to keep the patients occupied and briefly distracted before their next scheduled dose. On this afternoon, as Bernadette grew increasingly restless, I suggested a walk to the Rio Grande, which formed the western boundary of the clinic grounds. John and Bernadette reluctantly agreed. We left Lupita and headed toward the river.

2 i n t r o d u c t i o n

We walked slowly, the sun hot on our dark heads. I watched John and Bernadette concentrate on their legs and feet as they moved. Their steps were uncertain and deliberate, like the very young or the very old. They stopped for a cigarette break, during which they considered turning back. But by that point we were closer to the river than to the clinic. With my urging, we pushed on, our socks shot through with prickly thorns.

The walk to the river brought forth memories: of apple orchards and dirt bike trails, trout fishing and twelve- packs. John said the river was fuller back then and the crops that drank from the irrigation ditches it fed more abundant. We wondered about the coming monsoon, whether the rains would finally be strong and lasting; the region had been in a se- vere drought for the better part of a de cade. Then, for several minutes, we walked in silence.

“I can smell the water,” Bernadette said, her face glistening with sweat.

The edge of the river was lined with a thick tangle of brush. I led the way through it, pushing back angry branches and locating dry footholds along the muddy perimeter. Bernadette followed close behind me, and John followed her. We cleared the brush and then, suddenly, were stand- ing on the east bank of the Rio Grande.

The river was brown and shallow, its surface pebbled. We stared at the muddy water and remembered summer swims.

And then, Bernadette: “This sucks.” Not wanting to admit defeat, I suggested walking upstream where the

river widened before heading back. Bernadette lit another cigarette— she’d had it— and fell behind while John and I walked ahead without her. I imagined as we walked that we were looking for something to call forth our memories— perhaps schools of flickering minnows or deep pools of clear water. We walked quietly. After a few minutes, John stopped. “Mira [Look],” he said, pointing. Caught in a cluster of rocks lay a heroin cooker made of an old soda can, along with two discarded syringes.

“Este río está muerto [This river is dead],” John said. John lit another cigarette, and we turned back toward the clinic in

silence— our shoes heavy with water and mud. When we met up with Bernadette, John again announced that the river was dead. Bernadette

i n t r o d u c t i o n 3

looked at him blankly, and the three of us continued without speaking. When we arrived we found Lupita exactly where we had left her— bundled up and nodding off in the sun.

• • • • •

Later that eve ning, just before midnight, John disappeared from the clinic after eight days of heroin detoxification. He left behind his few belongings (muddy shoes, a weathered Bible, and a portable CD player) and walked a series of dirt roads that led to the main highway. From there he hitchhiked to Española, the nearest town, ten miles away. Be- cause his departure placed him in violation of his probation, the atten- dant on duty was directed to notify the police. John’s patient file was labeled “self- discharge against staff advice,” although it is unclear whether any of the staff advised him to stay.

The next morning police found John in his pickup truck, parked beside the garbage bins at the Española Dairy Queen. When they approached the driver’s window, they found John in a drug- induced sleep— in the passenger seat beside him an empty syringe. John was arrested. Three months later he was sentenced to return to the New Mexico State Peniten- tiary in Santa Fe, where he was to serve a two- year sentence for drug pos- session and outstanding warrants. In the eyes of the detox clinic, John was just another patient who had relapsed and failed treatment.

Since his arrest I have often wondered if John’s so- called self- discharge was precipitated by our encounter at the river. By all accounts he was do- ing well with his recovery program and was, in his words, “committed to kicking it this time.” Indeed, he seemed to have gotten over the hardest stretch of heroin detox— the first few days when the physical pain is at its worst. And the threat of prison was, he said, “enough to keep me straight.” What happened? Did John’s intimate recognition of the heroin cooker and syringes we stumbled upon awaken an overwhelming desire to get high? Or were there other, perhaps deeper dynamics of loss and longing during our walk that contributed to his relapse? How would I be able to begin to understand the motivations, force, and meaning of his “self- discharge”?

4 i n t r o d u c t i o n

Shortly after John’s arrest, I sat beside a different stretch of the Rio Grande near my house. A discarded Budweiser can, caught between fallen branches, shone brightly, like a medallion in the murky water. I poked at the can with an old wooden crutch that had been abandoned by the river’s edge. And everywhere, in the branches of the cottonwoods, among the black- billed magpies, in the weed- choked irrigation ditches, caught on barbed- wire fences, were discarded plastic bags emblazoned with the Walmart logo. Low Prices. Always. I recalled John’s words about the río muerto and wondered if it had ever been alive.

• • • • •

When I returned to northern New Mexico in January 2004 to begin re- searching heroin addiction, hypodermic needles seemed to be every- where. They were discarded along the tortuous county roads connecting the tiny, ancient, Spanish- speaking villages— Santa Cruz to Chimayó, Córdova to Truchas, La Canova to El Guique. They were tossed in the acequias— the centuries- old labyrinth of irrigation ditches that feed the valley’s crops. They were reportedly found in restaurants, schoolyards, and cemeteries. To my surprise, there were syringes hiding under the leak- ing sink of the house I rented, unused and forgotten.

For weeks, I surveyed my property, looking for sharp objects. I wore thick- soled shoes and moved across my acre of dry land methodically, in square- foot parcels. I didn’t find any syringes (except for those inside my house), but I collected dozens of broken beer bottles and other wasted objects. I also soon discovered that my next- door neighbor was a heroin dealer and, along with her boyfriend, operated her business out of her home. After witnessing a series of violent incidents at her house, I stopped wandering around my property and took to sitting in my attic window. For months, I watched cars spitting up dust as they drove up and down our shared dirt road. I watched her customers duck into her darkened adobe house and quickly reappear at all hours of the day and night. I lis- tened for the desperate sound of late- night knocking and the other sounds that often accompanied it: screams and blows and, sometimes, the shatter- ing of glass. And I watched my neighbor’s eight- year- old son running out

i n t r o d u c t i o n 5

of the house as though it were on fire and taking refuge in the tiny pump house, which sat just below my office window.

The ubiquitous and troubling presence of the syringes highlighted the extent to which heroin had become enmeshed in every aspect of phys- ical space and everyday life. They were everywhere in the landscape, on public land and private, tiny but dense sites in which history and subjec- tivity merged and, ultimately, disappeared. Anecdotes to a local reality, the syringes were imbued with alienation, desperation, and longing. They appeared to me as a kind of ghostly sign, like the handmade memorials called descansos (resting places) that line the highway, marking the site where someone died or was killed in an automobile accident.3 I understood my task as an anthropologist to conjure up the social life that produced these signs, to give it flesh and depth. Indeed, that is why I went to New Mexico to study heroin— to try to give purpose and meaning to an aspect of American life that had become dangerously ordinary, even cliché.

I grew up in New Mexico, leaving at the age of seventeen for the West Coast and later the East Coast. For years I would speak of New Mexico’s distinctive beauty, never of the deep suffering that I knew existed there.4

I kept memories of New Mexico separate in my mind— maintaining a firm boundary between what could be rendered (its celebrated land- scape) and what could not (the uncertain and secreted experience of ad- diction). But from my moment with John at the Rio Grande, I recognized that the two were inextricably linked. New Mexico’s landscape makes visible the existence of addiction, and addiction shapes and is shaped by New Mexico’s landscape. Each has its own pro cesses of sedimentation, which are entangled in ways that this book tries to understand.

g e o g r a p h i e s o f a d d i c t i o n

John’s moment at the river and subsequent relapse provide a powerful introduction to several themes that I explore in this book. First, there is the material and symbolic nature of finding the used syringe during our walk. I had suggested the walk to the Rio Grande precisely because I thought it would provide a respite from the many challenges of clinic

6 i n t r o d u c t i o n

life— from the physical pain of detox to the boredom and discomfort that accompany the clinic’s slow tempo.5 My plan seemed to work, at least before we got to the river itself. John’s and Bernadette’s memories of events that had occurred along the river harkened back to a time before heroin and its personal devastation. But seeing that even the river was, in a sense, contaminated by heroin pointed to just how deeply entrenched the region’s addiction problem was and would push me to address how there is ultimately no space— physical or experiential— external to it. Our discovery along the river would force me to address the way in which heroin haunts so many aspects of everyday life in this region, from the most public to the most intimate.

“Our landscape is everywhere spotted with ruins,” J. B. Jackson (1994: 15) wrote of northern New Mexico. This book starts from the idea that this par tic u lar geography of addiction encloses multiple forms of spatial and existential ruin, sedimented and entangled through time.6

As I learned the contours of John’s personal history, I came to under- stand that his declaration that the river was dead expressed a feeling of loss that was intimately connected to the social and po liti cal history of the region. This feeling, and the language used to describe it, resonated power- fully with many addicts I interviewed, especially as they spoke of memo- ries of dispossession and loss of land. Indeed, addicts’ narratives of heroin use were often related to mourning a lost sense of place.7 The presence of heroin here is closely connected to the multiple and changing ways that this land has been inhabited, labored on, “suffered for,” and lost (Moore 2006). A central theme in this book is how loss and mourning provide more than a meta phor for heroin addiction: they trace a kind of chronol- ogy, a temporality, of it. They even provide a constitutive power for it.

An important part of this geography of addiction is the growing pres- ence of the public health and legal apparatus. What I want to describe now are the high stakes involved in how these institutions classify and re- spond to events such as John’s relapse and how these classifications shape addicts’ understandings of their addiction and, by extension, themselves. In defining John’s departure from the clinic as a “self- discharge,” certain claims were made regarding his capacity and will to be a “good patient” and “good citizen”— that is, within the realm of the law or, in this case, his

i n t r o d u c t i o n 7

inability to be such. John’s “relapse” or “treatment failure”— purportedly neutral terms in a medical sense— would become morally charged by his subsequent arrest and imprisonment. The effects of these competing insti- tutional claims are a central concern of this book. I argue that such claims and the structures of authority in which they are embedded extend into the addict, presenting him or her with a new life script, such as “the pa- tient” or “the prisoner.”

By attending to the politics of what I call the patient- prisoner, I explore how the local phenomenon of heroin addiction and addicts themselves are constituted not only through hardship and loss but also through the logic, routines, and practices of medical and juridical regimes (Bourgois 2000; Lovell 2006; Rhodes 2004). Such an inquiry extends Michel Foucault’s (1979, 1998, 1990) inquiry into how forms of governance become forces for the creation of new forms of subjectivity. I work with a somewhat similar set of concerns in trying to describe how institutional structures and claims are absorbed by the addict, exacerbating a sense of personal failure that

8 i n t r o d u c t i o n

Figure 1. El río. Photo by the author.

contributes to a collective sense of hopelessness and, in turn, the regional heroin problem itself.

In this work, I approach heroin addiction as a human and ethical phe- nomenon that urgently requires understanding, especially as it can be il- luminated through ethnography.8 I also approach heroin addiction as an analytic in which culture, politics, and history coexist as a site of struggle and whose examination requires close attention to the personal and col- lective histories that form subjects and their drug use. By viewing addic- tion as phenomenon and analytic, I hope to show how Hispano addictive experience is closely related to history and not merely cultural or per- sonal pathology, as it is so often described. In doing so, I call attention to both the personal and po liti cal stakes of heroin addiction— its phenome- nology and its po liti cal economy, its intimate and institutional forms.

Anthropologists and others have established that the addict cannot be disconnected from the broader “moral world.” My analysis extends this insight by showing how specific geographies of addiction intersect with institutional and historical formations to shape the lives of addicts. In thinking about the connectedness of the heroin addict to the broader moral world, I have attended to the many spaces, roles, and identities “the addict” inhabits.9 This approach stands as a critique of pop u lar rep- re sen ta tions of addicts as separated from “traditional” social and intimate bonds, or as isolated from parents, children, and community. Though many addicts do experience isolation, I question the notion of the &#x

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