Addiction, adolescents, and the afterlife of therapy
— Reviewed by
Todd Meyers. The Clinic and Elsewhere: Addiction, Adolescents, and the Afterlife of Therapy. Seattle: University of Washington Press, 2013. Paperback, 160 pp., $25.00.ISBN 978-0-295-99241-9.
Author Todd Meyers describes The Clinic and Elsewhere as ‘a long essay on the anthropology of therapeutics and the management of life through pharmaceutical intervention’ (p. 9). It is, indeed, an essay, in the sense that it is an attempt to grasp the various meanings of clinical encounters among adolescent patients. It is a must-read for anthropologists of drug use and addiction, as well as for other scholars who want to better understand adolescents’ experiences of drug use and abuse. Each of the six main chapters examines one piece of a larger multifaceted picture, in which ethnographic descriptions, anthropological inquiries, and philosophical perspectives are combined in innovative and compelling ways.
For nearly three years Meyers conducted an ethnographic study of opiate-dependent adolescents in a drug rehabilitation treatment center in Baltimore, Maryland. He followed twelve young men and women, fourteen to eighteen years old, from the time they entered residential group treatment, where they were being treated with a relatively new drug for opiate withdrawal and replacement therapy: buprenorphine. The backgrounds of the adolescents varied widely in terms of their economic situations, demographic characteristics, how they came to use and abuse opiates, and the paths that led them into treatment. Interactions with the adolescents also varied considerably, as exchanges with ‘study participants’ depended on ‘multiple phone calls, dropping in unexpectedly, missteps, chance, and very often disappointment’ (p. 6).
The Clinic and Elsewhere is part ethnography, as the reader comes to know more about the lives of the youth during their time inside and outside the drug rehabilitation center, and the various ways they each ‘took’ their buprenorphine differently. In the introduction, Meyers takes the reader by the hand: ‘We step into the reception area of the treatment center’ (p. 3). He then describes meetings and phone calls with the adolescents whose addiction and therapy form the principal focus of the book.
He came to know Heather, for example, during her final stay in residential treatment and the first few months after she left. Once she disappeared into the juvenile justice system, however, it became impossible to maintain contact with her. From medical staff, Meyers learned that she had been sent to live with relatives in Baltimore. Jeff is another case. When Meyers first met him, Jeff was ‘pale, bruised, and sweating’ but trying to ‘sit stoically’ in the intake room (p. 49). In later meetings, Jeff offered ‘uncanny’ descriptions of his experiences, including how substances enter and leave the body ‘like a force of possession’ (p. 55). After ‘getting straight’ and dropping out of treatment, Jeff returned to the drug trade, and several weeks after their last conversation, Jeff died.
More prominent than these ethnographic portrayals, however, are Meyers’s rather abstract philosophical explorations. It is significant that before Meyers describes his entrée into the clinic, he quotes Nietzsche’s (1882) Gay Science. In this quote, the nineteenth-century German philosopher proclaims that there are ‘innumerable healths of the body’ and abjures the concept of ‘normal health’ (p. 3). Meyers uses a philosophical framework to make sense of the lives of adolescents inside and outside of the clinic, and to reflect on his findings that clinical reasoning sometimes ran alongside, and at other times completely counter to, individuals’ experiences with therapy. In fact, his anthropology of therapeutics is less informed by ethnographers than by philosophers such as George Canguilhem (1989, 2008), Gilles Deleuze (2000, 2006), and Michel Foucault (1977, 1988).
This approach makes the essay interesting and thought provoking, though his abstract theoretical considerations also make for a demanding read. The Clinic and Elsewhere focuses on the tensions between curing and healing, the efficacy of a therapy both inside a clinical trial and outside the parameters of research, and the point at which the clinical and the social become difficult to distinguish. Throughout the book, Meyers follows several key research questions. It is not always easy to understand how his intellectual reflections inform the reader about the intricacies of the various lives of the adolescents he followed, however. Verstehen, in the sense of understanding the insider perspectives of the adolescents, is not an easy task, and Meyers seems to be aware of this. It was difficult, for instance, to find words to capture the experience of opiate withdrawal. Jeff told him so: ‘Even if you was standing right next to me, asking me questions, you’d have no idea’ (p. 115).
Still, Meyers’s book is full of stimulating ideas. It does not call into question the criteria for evidence in clinical trials, and does not claim that conclusions from existing research are false. Instead, he sheds light on the complexities involved in treatment trajectories that are unobserved in the clinic, and asserts: ‘Perhaps it is too much to accept the idea that the trajectory of a treatment can vary so uncontrollably, never reaching an end’ (p. 118).
Meyers focuses on ‘the nature of evidence in medicine’ (chapter 1: ‘New Uses for Old Things’); ‘the space of opiate withdrawal’ and the expressions, affects, feelings, and concealments of the ‘patient-subject’ within ‘therapeutic space’ (chapter 2: ‘Monasticism’); and the production, assignment, and management of danger and risk in the context of both licit and illicit drug use (chapter 3: ‘Appropriations of Care’). He then turns to how public attitudes toward drug abuse and treatment shape medical concern (chapter 4: ‘Therapy and Reason’), followed by the various ways adolescents take up the category of ‘the patient’ (chapter 5: ‘Patienthood’). In the concluding chapter ‘Disappearances’, Meyers attempts to shed light on the disappearances and deaths of some of the adolescents he followed. This final chapter dwells on, in Meyers’s terms, ‘presence and its transformative power’ (p. 17).
Ultimately, Meyers’s essay is a remarkable combination of abstract and figurative sketches of adolescents in the clinic (and elsewhere) accessing pharmaceutical treatment for opioid addiction. When he writes that his conversations with adolescents reminded him of ‘the impossibility of “telling” certain forms of experience, of the limits of narrative to reproduce (represent) bodily experience’ (p. 51), he doesn’t refer to similar experiences of other ethnographers. Instead, and this characterizes The Clinic and Elsewhere throughout, he mentions Francis Bacon, one of the most radical painters of the twentieth century, whose paintings, ‘delimit the space where his bodies reside’, and writes that his own ‘attempts to capture the process of opiate withdrawal utilize the same method of delimiting – and “feel” the same constraints, and encounter the same dilemmas’ (p. 51).
About the author
Jeroen Boekhoven, PhD, is a social scientist at the Academy of Social Studies at the Hanze University of Applied Sciences in Groningen, the Netherlands. He also is a member of the Addiction Science Research Group of Hanze University.
Canguilhem, Georges. 1989. The Normal and the Pathological. Translated by Carolyn Fawcett. New York: Zone Books.
Canguilhem, Georges. 2008. Knowledge of Life. Edited by Paola Marrati and Todd Meyers. Translated by Stefanos Geroulanos and Daniella Ginsburg. New York: Fordham University Press.
Deleuze, Gilles. 2000. Pure Immanence: Essays on Life. Translated by Anne Boyman. New York: Zone Books.
Deleuze, Gilles. 2006. Francis Bacon: Logic of Sensation. Translated by Daniel Smith. Minneapolis: University of Minnesota Press.
Foucault, Michel. 1977. The Birth of the Clinic. Translated by Alan Sheridan. New York: Vintage.
Foucault, Michel. 1988. Technologies of the Self. Edited by Luther H. Martin, Huck Gutman, and Patrick H. Hutton. Amherst: University of Massachusetts Press.
Nietzsche, Friedrich Wilhelm. 1911. Gay Science. Translated by Oscar Ludwig Levy. New York: Macmillan.