48 pages • 1 hour read
Angela GarciaThe Pastoral Clinic: Addiction and Dispossession along the Rio Grande
Nonfiction | Book | Adult | Published in 2010A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
IntroductionChapter Summaries & Analyses
Introduction Summary
The Española Valley has the highest rate of heroin-induced deaths in the United States, as well as extreme poverty and high rates of domestic violence. The impact of heroin is felt by everyone; nearly everyone in the region knows at least one person who has overdosed on the drug. When Garcia returns to New Mexico in 2004, she finds hypodermic needles everywhere: roadside ditches, schoolyards, restaurants, and her own front yard. Heroin-related deaths are marked by descansos, small memorials like those found by the roadside, often in the shape of a cross. Garcia is interested in how New Mexico’s landscape, immortalized by writers and authors within the pastoral tradition, which idealizes rural life, relates to individual experiences with drug addiction.
Garcia opens the chapter with a description of a heroin rehabilitation clinic—a small house in the Española Valley countryside. John, Bernadette, and Lupita, patients at the clinic, sit outside with Garcia while they wait for their next round of medications. Garcia took the job at the clinic to expand her ethnographic research on heroin addiction in the area.
People who use heroin describe a sense of losing themselves while using the drug. Heroin impacts all bodily systems, including the central nervous system, and the individual experiences sedation, euphoria, and analgesia (pain relief). However, the feeling is short-lived, and people using heroin find they must continuously increase doses to feel similar effects. Soon, the drug is no longer used for its euphoric effects and is instead used to keep withdrawal symptoms at bay. Heroin overrides the brain and demands constant attention, making it extremely difficult to quit and maintain sobriety.
Patients at the clinic typically stay for a few days and leave. One patient named Marisa told Garcia that she was trying to recover for the sake of her children. Fellow staff members warn Garcia not to get too close to patients; self-discharge rates from the clinic are at 90%. Many of the patients tell Garcia that they feel as though their addiction has no end.
Hoping to encourage the patients to take their minds off their medicine, Garcia asks if they would like to walk to the Rio Grande. Lupita stays behind, but John and Bernadette reluctantly agree. When they reach the river, they find it muddy and shallow. Bernadette gives up, but John and Garcia continue to walk. They stumble across a heroin cooker and syringes. John looks at the river in defeat: “Este río está muerto [The river is dead]” (3).
Later that day, John discharges himself from the clinic. The next morning, he is arrested when police find him sleeping in his truck next to an empty syringe. Garcia wonders if John’s story might have ended differently if the river had been alive. Both John and Bernadette remembered the river before heroin became common in the area. John’s statement echoes writer J. B. Jackson’s assessment of northern New Mexico: “Our landscape is everywhere spotted with ruins” (7). The loss of Spanish and Mexican land grants and the impact of colonization developed a pattern of generational trauma and grief. Garcia asserts that the loss of land is felt by the Latinx and Hispanic citizens in the region and that this loss is directly connected to the prevalence of heroin addiction.
Garcia turns her attention to the institutionalization of heroin addiction and recovery and dismantles the language used within this context. John’s departure from the clinic was noted as a “self-discharge,” suggesting that John was in full control of his actions. Garcia further argues that the term “relapse” and the reframing of addiction as a chronic illness causes people with a substance abuse disorder to internalize a narrative of inescapability. She asserts that institutions trap individuals with heroin addiction in a patient-prisoner cycle, resulting in repeated stints in treatment or prison. Garcia argues that dissecting institutional structures and how they impact patients, as well as a comprehensive understanding of Latinx and Hispanic history and culture, which she suggests directly relates to the experience of addiction, sheds light on the complexities of drug addiction and a systemic sense of hopelessness.
One cultural aspect that Garcia considers is the emphasis on kinship within Latinx families. Family members, friends, and neighbors often help people with heroin addiction, even providing them with heroin to stave off the effects of withdrawal. Garcia notes that it is important not to think of these acts as perverse. Instead, these acts often fill the gaps left behind by institutional neglect. This understanding of addiction challenges the accepted stereotype in which people are isolated by their addictions. A local police officer shares with Garcia that many arrests occur at cemeteries, where family members use heroin while mourning someone who died from heroin use.
Introduction Analysis
In the Introduction, Garcia outlines her research methodology and the contexts that inform her work. The Pastoral Clinic falls within the phenomenological category of anthropology, an approach that combines philosophical and qualitative research to understand people’s experiences as they perceive them. She examines human experiences from both emic and etic perspectives while recording patients’ stories by using qualitative research methods. An emic perspective involves adopting an insider point of view. Garcia’s emic perspective comes from her own background in New Mexico and her work in the clinic for patients with heroin addiction. An etic perspective is an outsider point of view, which emphasizes categorization and generalization. Despite working closely with the clinic’s patients, Garcia also maintains distance between herself and the experiences of her research subjects, occupying both spaces of insider and outsider. Her connection with the region causes her subjects to open up to her in ways they would not with other researchers, but there is still a sense of Garcia’s otherness.
Cultural relativism is an important aspect of Garcia’s anthropological work. She emphasizes the importance of withholding judgment about the subjects of her study, as well as the cultural components that inform the prevalence of heroin addiction in the Española Valley. For example, she recognizes that family members are often responsible for supporting the drug use of individuals who have cycled in and out of the prisoner-patient pipeline. In this context, “patient-prisoner” describes the experience of the drug court system, which effectively incarcerates individuals with addictions in drug treatment centers. Since these programs don’t prioritize transformation and prevention, patients often relapse and end up back in treatment or in prison. Garcia also reports stories of family members who smuggle heroin to patients who are in the middle of detoxification to help alleviate their pain and suffering. Rather than condemning these actions, Garcia illustrates how family members often fill the gaps left behind by inadequate and underfunded institutional support and that these actions reflect larger cultural characteristics of kinship and caretaking. Garcia uses these descriptions to provide a deep contextual understanding of heroin addiction and its relationship to various aspects of culture and society. Rather than accepting simple narratives such as those perpetuated by institutional interpretations of addiction, Garcia offers a more nuanced understanding of patients’ experiences and how culture, land, and history interconnect to produce certain outcomes.
Garcia’s use of cultural relativism informs the descriptions of her patients. She is careful to protect their names and stories, and she shares their experiences with empathy and contextual understanding. The work opens with John’s story to illustrate the theme of The Connection Between Space and Experience. Residents of Española Valley find death and destruction everywhere they turn. Garcia argues that understanding the prevalence of heroin addiction in the region requires an understanding of the land and how its loss, extending back to the United States’ acquisition of Mexican territory in the 19th century, created a cycle of inescapable grief. Garcia describes the syringes as a powerful symbol of this loss:
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 (6).
These descansos show how culture, history, land, and experience—particularly the experience of addiction—interweave and interlock. Garcia uses the Spanish words for items used within this culture (rather than only using their English translations) to underline these cultural aspects and create a deeper connection with her subjects’ experiences.
In the Introduction, Garcia also opens a Critique of Conventional Approaches to Addiction Treatment. She argues that the treatment of addiction as a chronic illness places it alongside diseases like asthma and diabetes, emphasizing that it is inescapable and never-ending. People with addiction internalize The Institutional Shaping of Identity, which tells them that they are prone to relapse and likely will. When addiction first began to be treated as a chronic illness in the 1960s, medical providers hoped to eradicate the narrative of a patient’s moral failure, emphasizing instead the chemical effects of drug use and how they rewire the brain. However, Garcia suggests that this model is imperfect and has negative consequences for patients’ mental health. In the following chapters, she intends to unpack how scientific understandings of addiction impact an individual’s experience with drug use.
