Angela Garcia’s The Pastoral Clinic

The Pastoral Clinic: Addiction and Dispossession along the Rio Grande

by Angela Garcia

University of California Press, 2010. 264 pp., US$24.95 (paperback).


Angela Garcia’s magisterial, unsettling account of heroin addiction among a Hispanic community in Espanola Valley opens with a description of Nuevo Dias, a rural detoxification facility for drug users.  Accepting the executive director’s challenge to “work” rather than “observe” (29), Garcia conducts fieldwork while acting as a medical attendant responsible for dispensing medication and supervising patients going through heroin withdrawal.  The account offers an alternative perspective to ethnographies of North American medical facilities that foreground the authority of the clinic’s gaze and objectifying rituals.  Instead, Garcia presents the clinic as a “purgatorial space” (53) hampered by inconsistent staffing, inadequate funding and shortages of medications.  The care Nueva Dias provides is experimental, inconsistent, and, in most cases, unsuccessful in treating the complex set of ailments that cause patients to continually cycle through its doors.  The text is committed to showing that these shortcomings at the clinic cannot be separated from the physical geography and troubled history of this region.  When asked by a local resident to identify the most troubling problem at the clinic, Garcia replies simply “life outside” (191).

The Pastoral Clinic also deliberately diverges from many of the conventions in American social science research on illicit drug use.  Though concerned with suffering and the consequences of various forms of inequality, Garcia focuses on family dynamics in a rural community instead of presenting the cultural or economic rationality of an urban drug using “scene” or “sub-culture”.  In her attention to how heroin use is part of a more general “dynamics of connectedness and longing” (10) in Espanola Valley, Garcia tends to emphasize encounters that left her feeling disoriented or confused.  Her habit of starting and ending chapters with questions–either her own or others she encountered in her fieldwork–is one example of a style of writing that is committed to conveying the unsettled experience of lives marked by both rupture and a painful repetition of past histories.  In dialogue with a range of anthropological and philosophical figures ranging from Butler to Wittgenstein to Sophocles, this text is less an exercise in cumulative theory-building than a strategic engagement with thinkers that help Garcia express aspects of the latent meaning of her informants’ struggles.

The second chapter, “The Elegiac Addict,” explores the ways in which this region’s troubled history comes to shape the everyday lives of those in Espanola valley.  Garcia discusses how the harsh, beautiful New Mexican landscape has served as a site of dispossession that stretches back for generations.  Tierra Amarilla, a nearby village where longtime Hispano settlers were forced from their pastoral lives in the mid-19th century to create a national forest, represents a still unhealed wound that reminds local residents of what has been lost.  Though there have been periodic attempts by activists to reassert earlier claims on the land, more recent waves of dispossession–legacies of loss in the Vietnam war as well as more recent neoliberal policies, greater income equality and rates of incarceration–have further contributed to the plight of the Hispano settler community.  Today, most of Garcia’s interlocutors live in trailer parks, expelled from the houses and land they were connected to as children.

Garcia introduces “melancholy subjectivity”, a reference to Freud’s discussion of melancholy as a condition of “a mourning without end”, to portray the weight of a suffering that her informants describe as “sin termina” (91).  For Alma, a woman struggling with insomnia as well as heroin addiction, the relationship between her ongoing suffering and the events that perpetuate it have become dislocated in her narrative as “phrases of pain dangled precariously, isolated utterances that seemed to speak, as it were, for themselves” (79).  Garcia explores how this ongoing pain is, in part, the result of an ethical commitment of her subjects to follow local Hispano traditions that encourage the commemoration of deceased loved ones.  She makes the intriguing observation that the hardships of this cultural work of mourning are exacerbated by both biomedical and popular understandings of heroin treatment that tend to emphasize the “endlessness” of the condition of addiction.  Evangelical Christianity and its promise of a break from the past through the process of being “born again” is an appealing alternative for certain Espanola Valley residents who otherwise feel condemned to a lifetime of suffering.

It is within the context of this “endless” loss and dispossession that we come to understand the multiply productive role of heroin as both poison and medication – at once destroying jobs, friendships and the bodies of those that use while at the same time acting as a “life source” (202) sustaining various co-dependencies, alleviating suffering, and helping people to sleep, forget, dream and connect to what once was.

In “Blood Relative”, what is perhaps the book’s most moving and original chapter, Garcia explores the dynamics of inter-generational heroin use through a detailed account of her relationship with two pairs of mother and daughter “co-addicts”.  Garcia’s continual involvement in these women’s lives as they move between drug treatment, prison, and bouts of active drug use shows how they attempt to negotiate “a complex politics of kin, love, and mourning”(149).  The Spanish word for inheritance, querencia (a term also rendered as “love of the land”(101)), takes on new meanings as kinship ties are maintained less by the traditional patriarchal movement of property than “the heritable experience of addiction”(115) and the circulation of the drug between mother and daughter.  The reader gains new perspectives on how this dependency comes to be understood and lived less as a disease located in individual addicted brains than a life-defining condition that flows between generations and “in the blood.”  The “coronas” (abscesses) on the arms of a daughter are identified as existing since birth (112) and heroin is a form of inheritance that identifies and bonds even as it destroys.

As a committed activist, the author documents with great frustration “the conflict between bureaucratization, privatizing interest, and local experience” (187) that leads to the temporary closure of Nuevo Dias while simultaneously re-inscribes blame for the valley’s continuing heroin epidemic on this poor Hispano community.  However, Garcia’s understandings of the problem of addiction in this community is too nuanced to allow her to make the reductive arguments that are most effective in marshaling financial resources: She knows that even the treatment provided at well-funded and well-stocked clinics on their own are inadequate to heal wounds that are as much the symptom of a lingering past as the physiological dependence on heroin.  Thus, she finds herself confronted by a dilemma–how to convey the deep-seated suffering caused by this history of dispossession without contributing to the apparent endless and intractable problems of Espanola Valley.

Garcia answers this challenge through an extended consideration of epistemological questions concerning social commensurability and the possibilities of feeling and responding to another’s pain.  In Chapter One, she draws on her own experience when, on her first night on the job, the power goes out and she spends hours in the dark accompanying a sleepless patient undergoing the agony of early opiate withdrawal symptoms.  A particular type of sustained intimacy and common vulnerability creates the conditions upon which new types of care are possible (68).  Later, in exploring the “existential murk” of heroin overdose (Espanola Valley suffers from the highest rates of overdose fatality in the country), Garcia argues that “life”, even when individuals contemplate hastening its end, “is not lived in the singular” (152).  In reflecting on the overdoses that occur during her fieldwork, she argues “watchfulness”–a presence and being-together built through a form of social commensurability–creates ties that are at once vital, persistent and intimate (182).

The book ends with Garcia’s post-fieldwork return to the newly re-opened Nuevo Dias, an institution that weathered a fiscal crisis and survived, albeit in a reduced state.  Despite their struggles, the staff and patients have begun to farm on the rural clinic grounds, a development that Garcia finds inspiring not only in its transformation of the surrounding landscape, but also for its therapeutic possibilities.  The problem that addicts, the wider community, and even the clinic itself face is not, as a land activist claims, that they lack “a tie to their history” (94).  Instead, the challenge is finding ways to create ties to the past that offer possibilities for building communal lives that cohere in new ways in the face of destructive patterns that make local residents feel they “can’t go back anymore.”  Re-establishing a connection to the same fertile valley floor that previous generations of settlers once farmed is a preliminary step towards finding firm ground on which to stand, and new ways of living with and through the past.


Nicholas (Nick) Bartlett is a PhD candidate in the Joint Medical Anthropology program at the University of California, San Francisco and Berkeley. His dissertation research explores the intersection of history, memory, and recovery among a community of longtime Chinese heroin users. He previously worked in the public health field on drug-related issues, also primarily in China.

One Response to Angela Garcia’s The Pastoral Clinic

  1. La importancia de la crítica a la cristología de san Pablo, radica en que nos aporta los elementos de juicio necesarios para darnos cuenta __de la omisión capital que cometió Pablo en sus epístolas al mutilar la naturaleza humana de Cristo. Desechando la prueba viviente en Cristo hombre de que es posible alcanzar la trascendencia humana practicando las virtudes opuestas a nuestros defectos hasta adquirir el perfil de humanidad perfecta, patente en Cristo (cero defectos). Doctrina sustentada por filósofos y místicos __y de la urgente necesidad de formular un cristianismo laico enmarcado en la doctrina y la teoría de la trascendencia humana, a fin de afrontar con éxito los retos y amenazas del Islam, el judaísmo, las corrientes de la nueva Era y la modernidad.

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