The Clinic and Elsewhere: Addiction, Adolescents, and the Afterlife of Therapy
by Todd Meyers
University of Washington Press, 2013
172 pp, US$25.00 (paperback)
The Clinic and Elsewhere is an extremely well-crafted account of the methodological, conceptual and narrative problems of knowledge and life of the afterlife of drug therapy. Todd Meyers gives expressive form to the attempt to cure, to knowledge of this attempt and to the distance between cure as a clinical practice and healing understood as the subjective transformation of the lives of the young people he met.
Meyers reads his experience with this group, inside and outside a detoxification clinic in Baltimore, through his ongoing work on the oeuvre of Georges Canguilhem. Together with Stefanos Geroulanos, they have done Anglophone readers of Canguilhem (and others such as Henri Atlan) a great service in their translation and editing of important works in medicine and life sciences through their Forms of Living series with Fordham. In conversation with Canguilhem, Meyers asks whether and how a pedagogy of healing is possible: Can these young people we meet heal in the afterlife of clinical therapy? “The drug works” as the clinician tells the anthropologist, “but in the long term things begin to fall apart.” It is in the attention to falling apart, of how to narrate breakdown and recuperation, of the limits to clinical and anthropological knowledge, that Meyers’ narrative and observational skill comes to the fore. Anthropologically this book is a bold eschewal of taken for granted modes of anthropological knowing external to that of clinical reason: the narrative mode of anthropological writing of what it might mean to cure and heal is as much a problem as the breakdowns in clinical knowledge.
What could be learned, where one could be lead if one began to look at the limits of the space in which cure is known, of the distance between cure and healing. This is not, he explains, a denunciation of clinical reason. Rather, it is an effort to give form to breakdown: Meyers does this in at least two ways (there may be others): one is a configuration of insides-out; and the other is “serial” form.
Insides out.
What happens when insides are outside? What forms do insides-out take? Inside the clinic there is noise. A lot of noise. The space of the clinic seems to be a space for the recalibration of noise, signal and silence. A young man called Jeff describes his experience of his body when using opiates as silent. The silence of the body that is high is, clinically, pathological. The homeostatic normal of the (overly) drug using body needs to be recalibrated: New norms are needed.
In the space of the clinic one of the norms is normal noise: shouting, screaming, echoes, movements, clacks and screams, of bodies in pain, of words solicited and expected, and demanded. It is against this norm of noise that signals indicating cure can be measured, a pathway to a different, new norm of the silence of the body.
Meyers sketches the normative threshold of the Baltimore clinic, a former monastery, in figural and ethical terms. Inside the monastery is a space in which the drug – opiate replacement therapy – works. Or else, it is a space in which its effects can be known, where it does something, which is something the clinicians can know clinically and statistically. Meyers gives us a peek inside the former monastery and a figure of the therapeutic threshold:
“Along a hallway wall of the treatment center hangs a small picture of Christ leading a group of his followers along a rocky path. The print is yellowed and its placement on the wall inconspicuous. Each time I would pass the image I would wonder if it had been intentionally left hanging because in some way it was representative of the treatment process or whether it had simply been overlooked.”
Is redemption hidden at the heart of this treatment center – to be freed from a bad and to be moved towards a better situation-or has it simply been forgotten? Is the motion towards an “elsewhere” outside of the clinic at the heart of this practice or has it been neglected?
The clinician followed up his characterization of the long term and its fate to breakdown in a way that actually opens out away from a binary of therapeutic redemption or a negligence towards healing: “[to Meyers] of course, you’re right about trying to capture other factors, but that’s a social science problem. Come on, it’s your department.” Norms inside the clinic are one thing. Outside the clinic they are another.
Meyers explains that his study begins in the afterlife of treatment at the threshold where clinical knowledge ends. Within the clinic the standard of care is uniform: There are rules. There are forms. The staff know what they can do for these young men and women, teenagers, who are addicted to opiates. The clinic isn’t equipped to follow the afterlife of the therapy’s effects, the afterlives of the adolescents we encounter: Ty, Devon, Heather, Jeff, Cedric, Megan, Laura, Kevin, Keisha. This in itself is not striking. That things break down in the long run is a clinical given: how they breakdown is another question: How Cedric and Megan use buprenorphine, the replacement therapy, in conjunction with other opiates, for instance. Therapy inside out, one might say.
Jeff, by contrast, was a clinical success. He really wanted to be clean. He wanted to get off drugs so as he could go back to selling drugs on the west side of Baltimore. He successfully got off drugs. He was then shot and killed while working. Knowing this serious and sad fact hangs over what we hear from within the clinic. It constantly reminds us that norms of better and worse are experimental, imposed to varying degrees by the milieus these teenagers find themselves in. Knowing this gives a different hue to Meyers’ conversation with him about detox, a process Jeff had gone through a number of times.
“Todd: Did you know you were going to come out the other end since you knew what it was like before?
Jeff: No one knows what it is going to be like. You can’t remember. I prayed. Fucked up, huh?
Todd: I don’t know.”
Meyers’ “I don’t know” seemed honest to me as well as poignant. Would cure lead to healing or would it lead elsewhere?
Series-Form
The methodological reflection in the book is ethically serious, as well as erudite: there is a refusal in the text to represent breakdowns; a refusal of récit. This refusal, however, is not of the work of anthropology. The refusal points to a question: what might you see if you couldn’t or refused to create a narrative form? I think Meyers’ response to this is ‘series-forms.’ He uses open and closed series of events to configure a movement of shifting series. What is crucial is that “Jeff, Ty, Devon, or “Jeff, Keisha, Kevin and Tanya” (for instance) in the last chapter “Disappearances”, are not simply terms in a series: they are not a formal sequence. Each name is itself a shifting sequence or series of which we try to understand the order and which is given an order by Meyers depending on what sensation or fact is being drawn out.
Kevin for example, has throughout most of his life been in a series of institutions, is known in different ways by his presence in and disappearance into these institutions. Who he is, institutionally speaking, is a sequence without a single ordering principle: Meyers’ task, I think, is not to make sense of Kevin, or to explain the different kinds of disappearance he encountered. Instead the problem and the task is to give a form to a series of sensations: of what successful treatment might have meant to all the young people he met, and how they each disappeared.
With Canguilhem we might say that the search for norms in an experimental milieu is marked by pathos, a pathos of things breaking down under experimental conditions, especially for these young lives who are suffering. This is as true for the Clinic as Elsewhere.
Anthony Stavrianakis is currently a Fernand Braudel postdoctoral fellow at the Maison des Sciences de l’Homme.
Image credit: Francis Bacon, Three studies of figures on beds, triptych, 1972