The Points Interview — Todd Meyers

Editor’s note: Points welcomes Todd Meyers, a medical anthropologist at Wayne State University, to discuss his new book, The Clinic and Elsewhere: Addiction, Adolescents, and the Afterlife of Therapy (Seattle: University of Washington Press, 2013).

meyers front cover1.  Describe your book in terms your bartender could understand.

The book tells the story of a small group of teenagers (some quite young) who abuse opiates (heroin, prescription painkillers) as well as other drugs, and what drug dependency treatment was like for them. I met most of them during their time at a residential drug treatment center in Baltimore – a treatment center that, oddly enough, was once a monastery. I was fool enough to attempt following them around for long periods of time to gain an appreciation of how addiction and treatment ­took shape in their lives – how these two “modes” (drug dependency and its treatment) blur in unexpected ways. And that’s really one of the key arguments of the book – that clinical activities and thought reach into this thing we call “the social” and vice versa, thus the title of the book, The Clinic and Elsewhere. All of the kids I followed were treated with a relatively new pharmaceutical therapy (buprenorphine) for withdrawal and replacement therapy, and I followed that treatment process through their time in residential care and back into their homes or other institutional environments. The book is simultaneously about the new pharmaceutical therapy itself – tracing its development and approval as a new treatment modality. The book is a bit theoretical (what are the experiential dimensions of therapeutics? of patienthood? of success and failure of medical intervention? of concern? etc.) and a bit straight storytelling (that is to say, it’s ethnographic, through I’m becoming less and less satisfied with the salience of ethnography as both the technology and product of fieldwork). I attempted, at times clumsily, to make sense of treatment and addiction alongside these kids and their families as they themselves struggled with its meaning.

That’s probably what I’d say.  But in full disclosure, the last time I had a conversation with a bartender it began with hearing how he makes his own bitters from plants in his hydroponic garden and ended with him describing his thesis project (something about lactose fermentation and legal aspects of local food production), so I don’t think the book would be much of a stretch.  In fact, that’s part of my effort – to present work in conceptual terms that is not completely foreign to a broad readership (though not to water things down by any means, keeping with the bartender analogy) – and at the same time I have tried to write against the anticipated trope of marginality. That last part is probably the hardest to convey convincingly. The book is not a series of reworked scenes from The Wire but instead attempts to demonstrate the slow, at times banal, at other times brutal ways in which both addiction and treatment take hold within the domain of individual experience (contrasting a perspective where treatment neutralizes addiction uniformly, or that the experience of treatment is largely unvaried).    Read More »

The Long, Proud Tradition of the Fourth of July Buzzkill

Celebratory drinking has fueled Fourth of July festivity from its inception in the years following 1776, when double rum-rations for the troops, endless toasts at formal dinners, and makeshift booze-stalls at public gatherings became norms. And it was not long before high-minded patriots began to worry over the excesses of republican revelry. Before the Fourth of July oration itself became well established, there emerged within and alongside it a recognizable (if unnamed) theme in Independence Day rhetoric: the identification of that very day’s public drunkenness with whatever was ailing the republic.

All was not well in this republic.
All was not well in 1837.

Over the years, Independence Day jeremiads have taken numerous forms, from grim warnings about public health and morals, to wry satire of overzealous exceptionalism, to the ferocious indictment of national shortcomings. Many have focused on intoxication as the essential expression of decay, of hypocrisy, even of delusion.

Complaints begin with the sheer recklessness of the traditional program of events. Read More »

The Points Interview — William Garriott and Eugene Raikhel

Editor’s Note:  Eugene Raikhel and William Garriott, editors of a just-out collection of ethnographic essays titled Addiction Trajectories (Duke University Press, 2013), share their views in response to the Points’ interview’s probes. 

addiction-trajectories-cover1.  Describe your book in terms your bartender could understand.

William Garriott (WG) and Eugene Raikhel (ER):  In Addiction Trajectories we wanted to introduce readers to current anthropological work on addiction, and to propose a conceptual theme which we think unifies much of this new research.  So the book does both of these things.  First, it presents several ethnographic case studies of addiction in contemporary settings ranging from Puerto Rico to Russia, to southern France, to West Virginia, to Las Vegas.  Second, it proposes the concept of addiction trajectories as a framework for understanding these particular cases.  We highlight three particular addiction trajectories: epistemic or knowledge trajectories, therapeutic trajectories, and experiential and experimental trajectories.  These terms capture three key elements of addiction:  the ongoing debate over what, exactly, addiction is; the myriad treatments available for addiction; and the experience of addiction. The term “trajectories” is meant to draw attention both to the different kinds of movement we see taking place in each of these dimensions (change over time, but also movement across social and geographic space) as well as the open-endedness of this movement.

Eugene Raikhel
Eugene Raikhel

2.  What do you think a bunch of drug and alcohol historians might find particularly interesting about your book? 

WG:  I hope they will appreciate the authors’ efforts to show, through ethnography, how history is lived.  Each chapter in its own way shows how the past is embodied in the present.  This may be, in the case of Angela Garcia’s chapter, how a history of land dispossession in New Mexico is implicated in contemporary experiences of heroin addiction, or, in Eugene’s chapter, how the legacy of Soviet-era addiction therapeutics continues to shape treatment of addiction today. Read More »

Dispatches from London: “Under Control?” Conference

This past weekend alcohol and drug scholars across the globe descended upon London’s School of Hygiene and Tropical Medicine to learn from each other about what they know best, alcohol and drugs.  The interdisciplinary conference does much to encourage scholarship across lines of disciplinary specializations, but also, the nation-state.  Below please find assorted notes from my time abroad:

Image

Perhaps most noted for his work Andean Cocaine, Paul Gootenberg gave a keynote speech addressing the concept of blowback.  Entitled “Controlling Cocaine?  1900-2000,” Gootenberg began with what might be considered an obvious truth for drug historians—that is, that if read from an historical perspective, the term “drug control” is an oxymoron.  Throughout the 20th century, drug control often perpetuates the antithesis of control.  Drug control efforts by the United States have bred more chaos, more illicit trade, more use, and worst of all, more violence.  In supporting his claim, Gootenberg examined the ways in which United States efforts to control the global supply of cocaine produced various unintended consequences.

Originally an economic historian by trade, Gootenberg makes good use of global commodity chains to explain the story of cocaine and attempts at its control.  In framing the long history of cocaine commodity chains and blowback, Gootenberg broke down the century into several distinct phases, each with specific unintended consequences.  In the first forty years of the 20th century, particularly after 1914, the United States attempted to push anti-cocaine measures onto the international agenda.  During this period, Andean trafficking in cocaine remained relatively benign, marginal, and nonviolent.  Between 1948 and 1973, cocaine came to be increasingly criminalized as illicit networks began to shift outward from the Andean region in response to FBN attempts to crush production in the region.  A pivotal moment in cocaine commodity chain development passed in 1960 when traffickers were exiled under the Cuban Revolution.  These exiled traffickers quickly became a Pan-American Network of traffickers, thereby expanding the commodity network for cocaine traffic.  Still though, Gootenberg carefully noted, the trade remained small and fairly peaceful through 1970. Read More »

The Points Interview — Eoin Cannon

Note: Points’ managing editor, Eoin Cannon, favors us, today, with an interview on his just-out, new book, The Saloon and the Mission: Addiction, Conversion, and the Politics of Redemption in American Culture  (University of Massachusetts Press, 2013). BTW, Big Congratulations, Eoin!

Cannon-coverDescribe your book in terms your bartender could understand.

Sorry, barkeep, but this book is about people who ceased to need your services and then made a realllly big deal about it.  It’s about how and why people have told stories of recovery from alcoholism publicly since the late 19th century.

I focus especially on the legacies of the “drunkard’s conversion” testimonies given in urban evangelical missions and circulated widely in print from the 1880s to the 1910s. Despite their roots in old-time religion, these stories’ urban class dynamics made them compelling to those who saw the knot of poverty, ethnic difference, and vice as a modern social crisis. In personal voices and realistic slum settings, the drunkards’ conversion stories defied the irreversible fates associated with these categories. The practical understanding of salvation they offered also made such tales susceptible to a wide range of interpretations. So instead of seeing conversion stories as individualistically oriented distractions from structural injustices — as skeptical readers today might — many reformers, artists, and intellectuals in this period retold them as stories that modeled a wider social healing by the lights of a variety of social theories, from radical to reactionary. In the context of this contested discourse around the meaning of the drinker’s redemption, literary writers through the modern period told stories of alcoholism with high stakes. The drinker’s descent was a character-based crisis, but one that plumbed modern society’s perceived maladjustment and, possibly, harbored clues to its regeneration.

This programmatic approach to redemption shaped the storytelling conventions available to the budding recovery movement in the 1930s and beyond. A.A.’s pioneers subsumed the contested aspects of the form into a recognizably Depression-era revision of the self, one that understood the limitations of individualism in social as well as in spiritual terms. In mutual-aid circles, these stories could remain highly pragmatic, devoted to A.A.’s “primary purpose.” But public recovery stories since the rise of A.A. have taken the social ethic of mutual aid beyond twelve-step culture and out into the wider society. These stories often depict recovery as the solution to a social problem or even as the model of an ideal society. As such, they have tracked the progress of liberalism since the New Deal era and, I argue, helped to shape its redemptive ethos in the realm of culture. Cannon

So while we may not openly contest the meaning of the modern recovery story, preferring to accept that it simply describes how a sick person got well, the story form is so constructed as to embody foundational claims about the self and its relation to others. If we as a society don’t agree on those claims, neither will we agree on the meaning of recovery — arguably a dissensus increasingly in evidence since the 1960s.

What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?

Most interesting might be the things they are most likely to question. First, I started my pre-history of recovery narrative in the postbellum rescue missions, rather than in the Washingtonian Movement of the 1840s. I placed a lot of weight on the secular implications of prevailing interpretations of mission testimonies, despite the fact that they had been preceded by an already secular movement a generation earlier. I did so because I found that the rescue mission stories were influential in mediating institutions — church homiletics, progressive reform, academic psychology, realist literature — which in turn informed the redemptive ideals and the storytelling styles more broadly associated with recovery in the 20th century. In other words, the rescue missions provided a master narrative of modern addiction storytelling. Read More »

The Return of the Crack Baby. Again.

“I think that if you say something three times out loud, people take it as fact. And also, I think there are certain ideas that people want to believe, that really fit in with cultural stereotypes, and it’s hard to get rid of those”– Claire Coles

I want to believe

A friend recently posted a Retro Report video about the crack baby myth on my facebook page with the comment, “you called this, like, a year ago.” Another friend emailed me the link and a note, “always ahead of the game, you are.” While I appreciate my friends’ propers, I should point out that people have been debunking the crack baby myth for over twenty years. The correction just can’t seem to stick. If I called anything, it’s that sad fact: we just can’t let go of the crack baby.

As I argued before, one reason why we can’t let go of this myth is that it has the structure of a conspiracy theory, one in which the conclusion is sacrosanct even if the evidence is not yet identified. We have such agile, creative minds, and we really want the crack baby to be real because it has the ring of truthiness. Just the other day, a friend tried to grok the crack baby that wasn’t and concluded that crack still did something – even if that was just to stand in for all the other awful consequences of using crack and, of course, it’s true: some of those awful consequences can have very damaging effects on a human being. I had to agree: in that way, yes, one could say that there is such a thing as a crack baby.

This is not the first time the New York Times has run a story about what it called (in 2009) “The Epidemic That Wasn’t.” A cynic might wonder if maybe debunking the myth has become almost as good a story as the crack baby him or herself, even if it does require a journalistic mea culpa. Perhaps this is a second reason for the persistence of the crack baby myth: saying there is no crack baby makes for some great copy.

The Epidemic that Wasn't
In an article about how crack babies grew up to be fine, the NYT opted for this photo and this caption: “In a 1988 photo, testing a baby addicted to cocaine.” A person could see this photo and caption and get the wrong idea. Seems the NYT couldn’t completely give up on the crack baby in 2008, either.

Read More »

Collier’s 1943 Snapshot of the First Yale Summer School of Alcohol Studies

Note: Readers are encouraged to send potential leads, sources, or thoughts relating to E.M. Jellinek’s life to Judit Ward, at jhajnal@rci.rutgers.edu, or Ron Roizen, at ronroizen@frontier.com.  With thanks in advance, from both of us.

Jellinek and YSS women students 1943“IF YOU saw an Anti-Saloon Leaguer shake the hand of a saloonkeeper,” wrote Amy Porter in the October 30, 1943 issue of Collier’s magazine, “and the two of them walk and talk together as thick as thieves, your first question might well be: Where am I? The answer would have to be: At the School of Alcohol Studies at Yale. Nowhere else, probably, has such an event taken place.”

Placed adjacent these opening sentences was the happy picture shown above, featuring E.M. Jellinek, with a coyly grateful smile, flanked by two clearly delighted Yale Summer School students, one from the temperance tradition and the other from Seagram’s. Porter’s article was titled “Wet and Dry School” – thus telegraphing from the get-go that the new institution took no position on the great alcohol controversy and cultural schism that, by 1943, had preoccupied the nation for more than a hundred years.

Such magazines as Collier’s, Look, and Life provided the photo journalism of their day. Several photos of the Yale school’s activities, faculty, and students accompanied Porter’s text — these credited to Collier’s photographer Hans Knopf-Pix. Four are reproduced in this post.

Porter’s focus on the possibility of a happy coming together — call it a national reunion — of Americans around the alcohol issue illuminated an important and yet little discussed latent function of “the new scientific approach” to alcohol that Jellinek and his Yale school colleagues proffered. Read More »

The Points Interview — Kathleen J. Frydl

Editor’s Note: Kathleen Frydl’s new book, The Drug Wars in America, 1940-1973, is just out from Cambridge University Press. Points welcomes her timely and enlightening interview.

Frydl-book-cover 1.  Describe your book in terms your bartender could understand.

I tell the story of how and why the US government became “addicted” to the modern drug war, choosing prohibition and punishment over treatment and regulation. I argue that the logic behind the particular shape and targets of the drug war (including that which was not targeted) had less to do with crime or addiction, and more to do with the management of state power.

2.  What do you think a bunch of drug and alcohol historians might find particularly interesting about your book?

To be honest, probably not that much. At several points, I rely on that scholarship, but I can’t say that I actually contribute to it. For readers of this blog, it might be interesting — maybe even troubling, but hopefully stimulating — to hear the story of the drug war narrated through a different voice.  I hope it is viewed as a complement to the literature.

That said, there are some parts of the book that may be of interest. In chapter 5, I argue that methadone clinics lost support for a variety of reasons. Proponents of punishment, recovery movements, and various groups on the left imposed standard medical — as opposed to public health — criteria on maintenance: built around “a crisis followed by a cure” paradigm. This is somewhat different from the goals of harm reduction. Under this more demanding paradigm, the fact that every recovery victory could be celebrated  compensated believers for so much failure. In the public health lens, on the other hand, successful maintenance meant only less to be dismayed about. The outcomes were not so heroic and the narrative not so redemptive. Whether it was the Black Panthers or traditional recovery movements, certain advocates criticized maintenance precisely because it staved off the “crisis” which they felt was needed in order to proceed to the “cure,” whether that cure was sobriety or revolution in the inner city.

Read More »

The Points Interview — John Markert

Editor’s Note:  Hooked in Film: Substance Abuse on the Big Screen (Scarecrow Press, 2013), by John Markert, is due out in June.  Below, author Markert kindly offers his responses to the Points interview’s palatte of probing questions.

Markert-cover1.  Describe your book in terms your bartender would understand.

Few people have every used heroin or cocaine, yet just about everyone knows that you “shoot” heroin and roll a dollar bill to snort “a line” of powdered cocaine.  These images linger in the mind’s eye because we’ve seen people do this in the movies, even if the images are inaccurate — shooting heroin is rare today, though it continues to be the dominate route of administration depicted in contemporary film.

Movies in contemporary society are a primary way of imparting information about our social world.  We may rely more heavily on film to tell us about drugs than about other social topics since few people have first-hand knowledge about illegal drugs.  Movies, then, become a primacy source of information about who uses what kind of drug, the effect of the drug on the individual, how problematic the drug might (or might not) be in society, and what should be done about the problem, if, in fact, film frames it as a problem.

Heroin, for example, is clearly depicted in film as a deadly drug.  In film, you stick a needle in your arm and you’re as good as dead.  Film ignores the fact that many regular heroin users “chip” at their use and moderate their use depending on heroin’s availability. Film also ignores the fact that while 1.5 percent have played with heroin at some point in their lives, only 0.2 percent can be considered “regular” (past year) users, which means that many people who have experimented with heroin do not become addicts.  The deadly consequences of heroin use depicted in film, though not quite accurate, may not necessarily be a bad thing because it could discourage the casual experimenter from even considering trying heroin.Read More »

Confessions of an Historian of Secrecy, Science, and the Self

Editor’s note: We continue our celebration of the 40th anniversary of the publication of David F. Musto’s book with a contribution from cultural historian and American Studies scholar Timothy A. Hickman, whose first book, The Secret Leprosy of Modern Days, reconstructs (and deconstructs) the entrepreneurial therapeutics of the late 19th century historical world inhabited by Dr. Leslie Keeley, proponent of the famous “Gold Cure” for inebriety. Hickman recounts grappling with Musto’s capacious framework in the context of a post-Foucauldian intellectual moment.

Most historians of drugs and alcohol get used to the question, “So how did you get interested in THAT topic,” usually punctuated by a cocked eyebrow and an arch chuckle. My interest arose during the popular recovery movement of the late 1980s, when I read “As Sick as Our Secrets,” a Summer 1990 LA Weekly article by writer Helen Knode, who detailed her family’s troubles with substance dependence over the years. I was particularly taken by her claim that, if one were to multiply the number of “addicts” by the number of “co-dependents” asserted by recovery writers, the product would exceed the entire US population!

The fonts were just a symptom.
Bad fonts were a symptom.

What fundamental beliefs might underwrite the diagnosis of the entire American population as “dysfunctional”? Whose interests were met in defining a whole population as a target for therapy? What institutions benefited? What did this state of affairs suggest about American society, and why did millions of people ‘Just Say Yes’ to the recovery movement’s call?  Still more pressingly, what kind of a “disease” required confession as the first step to cure?

Read More »