The Silences of Our Work, Part I: A Preface

Editor’s Note: Points is delighted to welcome Heather Sophia Lee, PhD, LCSW, an Assistant Professor of Family Medicine and Community Health at Rutgers’ Robert Wood Johnson Medical School. Lee is a practicing clinician and qualitative researcher who studies how stigma influences access to health and social services. Today, Lee opens her series on silencing and substance abuse with a reflection on her relationship to this work.

Some months ago, Points co-founder Trysh Travis read an article I published about integrating harm reduction and twelve step approaches to treatment, and asked how I became interested in addiction research. My answer: I began observing addiction and recovery long before I learned to study these processes systematically. I was born into the witnessing of addiction; it began with my father’s struggles and untimely death when I was nine years old.

This experience exposed me to the scripted language of recovery at an early age. But I’d argue that, even for people without this early formative experience, the scripts of addiction treatment and drug policy manage to shape the psyche. I’ve witnessed many contrasting cases in which the dominant response model to drug and alcohol issues (i.e., punitive, abstinence-based, and informed by an explicit set of assumptions) failed to meaningfully reach those in need of help.

Later, as a clinician-scholar, I believed there must be a better way to engage those in need of help and began exploring alternatives. I acknowledged that the dominant model does reach some people– but it fails to reach most people, and that was the population I wanted to engage. As I reflect on my personal and professional experiences, I think my work has been driven by something deeper and less tangible than clinical efficacy: the greatest injustice in treatment practice and scholarship is the silenced voices of those who struggle with addiction. I also believe that by facilitating space to desilence those voices, we will learn about our failings and be better able to help those who struggle with substance use and misuse in this country.

Image via Harm Reduction Coalition (harmreduction.org)
Image via Harm Reduction Coalition (harmreduction.org)

I first encountered this silence as I witnessed my father’s last years. At that time, I could not name it, identify it, or pinpoint it. Later, in my professional life, I had the opportunity to articulate the systematic ways it occurs.

During the years that our lives coexisted, my father’s was complicated with suffering. Over time, I gathered bits of information about his life in what feels like a painstakingly slow piecing-together of a mysterious puzzle. I learned that his mother died when he was a child, as did his younger brother. I’ve been told his father, who also struggled with substance abuse issues, remarried and that his new stepmother did not want children so he and his other brother were raised by his maternal aunt and uncle. I’m told he dropped out of high school at the age of 17 to join the Navy and would later earn his GED. While in the Navy, he trained as a photographer and eventually become a cameraman at the Kennedy Space Center during the height of the space program. Recently, the son of one of my father’s bosses told me that my father shot the last photograph of the Apollo 1 astronauts. I’ve also been told he was a very talented motion picture photographer. Over the recent holidays, I sorted through boxes of his belongings, gone untouched for years, and discovered clues that, had I had the chance to know him, we would have had a lot in common.

In spite of these pieces of gathered information, the story which has figured most prominently in my psyche has been dominated by his assigned-identity as an “addict”. While this case example is deeply personal to me, my professional work has also taught me that once you’re labeled an “addict”, it becomes almost impossible for others to see other facets of you and your life.

In this process of labeling, much goes unsaid. The “why behind the what” goes unexplored – the “what” being the problematic use of alcohol and other drugs, and the “why” being the reason for one’s problematic use. The American script tells us that addiction is a disease and that the appropriate response is abstinence. The story is plain and simple; there’s not much room for nuanced understanding.

My complicated relationship to my father’s story is, admittedly, an emotional topic for me. I claim it as a subjectivity in my work. As a social worker and qualitative researcher, I’ve been privileged to be able to document the ways in which silencing occurs through the narratives and reports of people who struggle with substance abuse. There are many ways in which silence operates, but I think there are three that are particularly important:

Silencing the voice and self-determination of the individual struggling with their use;

Silencing their past trauma;

Silencing the resilient responses to this past trauma if they fall outside of what we believe to be “appropriate”.

Over the next several weeks, I’ll address the silences that exist in our work. Addressing these silences, I argue, will help us move beyond a rigid, punitive system to one that is designed to meaningfully engage individuals in processes of recovery which fit their individual lives and promote optimal living.

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