Angela Garcia is an ethnographer who wrote about heroin addicts in northern New Mexico. During her research, she worked as a detoxification attendant at a drug detoxification clinic. Her presence at the facility and her closeness to the subjects during their time of withdrawal led her to best understand the addiction and the control it has on people. Garcia writes about the clinic and the patients she encountered, the geographies of the addiction, and its chronicity.
The text begins with Garcia describing the clinic and its chaotic surroundings, from the clinic’s fragile state to the fidgeting patients. John, Bernadette, and Lupita are the three heroin addicts she introduces to us first, all whom have gone through the detoxification process previously. Her job at the clinic was to distribute prescription medications such as narcotic-based relaxants to ease the pain of withdrawal and to distract the patients until their next dose. She decides to take them on a walk to the Rio Grande as a way of getting their mind off of it, once they are there John notices a heroin cooker which later on seems to contribute to John’s relapse and “self-discharge” as it might have “awaken an overwhelming desire to get high”. The dead river and the heroin alongside it are examples of how spread the heroin is in the area, needles are discarded along the roads, in cemeteries, schoolyards and restaurants. Garcia soon finds out that even her neighbour was a drug dealer and had a young son who was involved in the process as well, which shows how normalized heroin has become.
The widely spread heroin and the fact that there seems to be no escape from it emphasizes the loss the region had suffered from and connects it to its social and political history. Garcia argues that the response (or lack thereof) to John’s “failure” and “self-discharge” is yet another problem in the detoxification system, it contributes to the feeling of hopelessness heroin addicts develop. Heroin addiction is more than just a problem individuals have, it is a cultural, historical, and political struggle that demands more attention. Even though people seem to view heroin addicts as isolated people seperated from society, Garcia insists on the presence of social and intimate bonds in an addicts’ life. Ties are even maintained through the way they share addiction from gifting heroin to funeral rituals for heroin overdoses. The loss northern New Mexico has gone through further explains the spreading of heroin and the way people seem to deal with it through addiction. Garcia recognizes that she can only understand and write about addiction and overdose to an extent, as they require forms of experience that exclude her.
The high percentage of “self-discharge” at the clinic was alarming, 90 percent of patients tend to leave and several patients return within weeks. The clinic uses excuses such as “we can’t save someone who doesn’t want to be saved” to justify the rates of relapse they seem to have. However, Marisa was a patient who was very determined to get clean as she says that she has a lot to lose if she doesn’t, she ended up leaving the clinic within a week. Garcia questions if what the clinic’s staff say is true then how come Marisa couldn’t be saved? Drug recovery is mostly understood as individuals’ will and power against their need to get high and the addicts’ reasoning and control over their drug-using behavior. Due to this understanding of recovery, relapse in patients is immediately blamed on them and their lack of will and control. At this point, relapse is an expected outcome and any other outcome is what is considered unusual, this does not only discourages the addicts to recover it also engraves hopelessness into their minds, therefore relapse is produced. The chronic need for heroin is often a result of alteration in the neurological circuitry for dopamine which triggers feelings of happiness and pleasure, in states of dopamine deprivation an addict would experience pain, depression and an extreme need for more heroin. Over time, with more frequent doses the drug becomes less about achieving high and more about easing the pain of withdrawal.
Garcia’s book (The Pastoral Clinic: Addiction and Dispossession along the Rio Grande) finds relation between the history of northern New Mexico and the heroin problem the region has and explores the alternative processes of “recovery” and their results. It demonstrates how the clinic’s conditions and vulnerabilities reflect the outside world and how loss led to heroin being a contemporary consequence.