"Timely, disturbing, and luminously written, The Pastoral Clinic is anthropology at its best, bringing into view a devastating piece of reality, highlighting larger processes and human singularities, and calling for a new public and ethics of care."—João Biehl, author of Vita: Life in a Zone of Social Abandonment

"Garcia calls for a new ethics of care for heroin addicts, exposing the insufficiency and lack of continuity of rapidly privatizing faith-based services for the rural poor. Her heartfelt ethnography of the geography of addiction in New Mexico reveals how formerly agricultural communities and families find themselves painfully embedded in a land of dispossession and displacement with an unresolvable past, and an unlivable present."—Philippe Bourgois, author of Righteous Dopefiend

"Angela Garcia has expanded the roots and basis of addictions to the great losses—personal, cultural, economic, of birthright and land—that few would dare to explore. I've sought a book like this for years, addressing my own addictions and those of the young men and women I've worked with for decades. A formidable thinker, a wrench-in-the-works activist inside and out of the industry, Angela understands that addictions are not a 'always has been and always will be' fate, but a collective, individual, and even 'intimate,' funneling into the web. And how the path toward healing, reconciliation, and wholeness is in the land, in the hand, and the capable heart of every addict and broken community."—Luis J. Rodriguez, author of Always Running: La Vida Loca, Gang Days in LA

Angela Garcia is Associate Professor of Anthropology at Stanford University.

The Pastoral Clinic

Addiction and Dispossession Along the Rio Grande

By Angela Garcia

UNIVERSITY OF CALIFORNIA PRESS

Copyright © 2010 Angela Garcia
All rights reserved.
ISBN: 978-0-520-26208-9

Contents

List of Illustrations, xi,
Acknowledgments, xiii,
Introduction, 1,
1. Graveyard, 37,
2. The Elegiac Addict, 69,
3. Blood Relative, 111,
4. Suicide as a Form of Life, 150,
5. Experiments with Care, 183,
Conclusion: A New Season, 205,
Notes, 211,
Bibliography, 223,
Index, 237,

CHAPTER 1

Graveyard

PAST AS PROLOGUE

The heroin detoxification clinic lies at the end of a typical road in the Española Valley. Little more than a path, the road is unpaved, deeply rutted, and strewn with shards of broken glass. Pack dogs roam along it and are prepared to chase—for a few moments at least—the occasional passing car or three-wheeled ATV. Crumbling adobe houses line the road, abandoned for newer trailer homes. The adobes and the trailers sit adjacent to one another, marking a transition between generations. Both are set on small plots of land once used for cultivating squash, chile, and corn. Like the adobe, artifacts of a prior agricultural life remain: there is the ubiquitous tractor, broken down and stripped of its tires; the empty storage shed, once brimming with apples. Both appear to be sinking into the land from the force of years, sun, and neglect.

The road to the clinic is like any other. Except for a small handpainted sign that reads "Nuevo Día," there is no obvious indication of institutional presence or, for that matter, of heroin.

* * *

The clinic spans several buildings. First, there is the cluster of small adobe houses, whose curved, earth-colored walls closely resemble the traditional architecture of the region. These surround a much larger, central building, whose gray-painted exterior and crisp lines suggest an institutional aesthetic. Like the adobe and the trailer, the juxtaposition of the clinic's structures suggests a transition from tradition to modernity, intimacy to order. During the early stage of its operation, the detox program was fully located in one of the adobe houses and was affectionately referred to as "la casita," the little house. However, as the program expanded to accommodate an increased patient load, it was moved into the larger building, and the term la casita fell out of use.

In the past the clinic was a state-run residence for mentally ill adolescents named Juniper Hills. Its patients were primarily from the Española Valley, and they suffered a range of afflictions—bipolar disorder, depression and schizophrenia, physical and learning disabilities, substance abuse. Many had a history of physical or sexual abuse, and some had had run-ins with the law. Despite its idyllic name, Juniper Hills led a troubled existence. It was underfunded, short-staffed, and overcrowded. The structure displayed scars wrought by its previous inhabitants: fist-sized holes in plaster walls, obscenities etched into windowsills. By the time I arrived, it was hard to tell to which institutional generation the scars belonged.

According to a former patient attendant at Juniper Hills, the sheriff's department was frequently called in to settle fights, or to take away the most unruly or the suicidal. Most of the kids would return after a few nights in juvenile detention, or "5150," the code for involuntary psychiatric evaluation. The sickest patients, the attendant said, "stayed inside like chickens," pecking at themselves and at each other, while the healthier patients sought refuge outside, spending long hours wandering the facility's expansive grounds.

The attendant was eighteen years old when he worked at Juniper Hills—the same age as many of its patients, some of whom he'd known since grade school. During his period of employment, he said he felt that he was "going crazy" himself, a feeling he attributed to the institution's unsettling environment. He recalled the lure of the Rio Grande, on the western boundary of the facility. Patients often escaped to the river like stowaways, wandering upstream or down. Most of them would return within a few hours; they had nowhere else to go. Usually, they would set off again, until a tall chain-link fence topped with barbed wire was erected along the perimeter of the grounds.

It is said that a young girl diagnosed with schizophrenia set fire to one of the Juniper Hills buildings. According to the stories, she died in the fire and the facility closed. Numerous people recounted the story to me in similar order and detail, which went something like this:

The girl was depressed, crazy. One night she locked herself into a room and started lighting matches. Her clothes caught fire and so did the room. But the girl didn't make a sound. She stayed quiet, even while she burned. Clearly, the girl just wanted to die, you know what I mean? Eventually, the other patients smelled the smoke, but by then it was too late ... no, I don't remember her name.

I consulted police reports and newspaper archives looking for "evidence" of the story. There was only the building itself; its walls were still scorched from the long-extinguished flames. For months, I visited the building as if I were visiting the grave of an estranged friend. Staring at its blackened walls, I imagined that the fire was still raging, that the girl inside was burning, and that the flames she started had spread to me.

Over time I began to understand the story of the girl who immolated herself as an allegory for the precariousness of Hispano life and as a means to situate the multiple and overwhelming wounds of past and present. Flowing through locals' recounting of the fire were sentiments of sorrow, helplessness, and rage. The story of the girl seemed to enable locals to talk about their deep ambivalence toward the very presence of the institution along the Rio Grande and their collective failure to have cared for such a girl, whatever her name may have been, or will ever be. Like the Mexican folktale of La Llorona, the Weeping Woman, the story's continued circulation seemed to insist that we must all be more careful next time—that we must listen more closely for the girl's silent cry.

After its closure Juniper Hills was again transformed, this time into a picadero, or shooting gallery. Several addicts described it to me as a perfect setting for heroin binges. Parts of the facility were relatively intact, providing shelter from sun, rain, or snow. There were beds, forgotten medical supplies, and bathroom mirrors, the latter of which enabled addicts to inject heroin into areas of the body that were otherwise impossible to see. Juniper Hills remained a popular picadero even after the rodents, mold, and asbestos set in. Eventually, county officials considered condemning the building, but a 1999 special congressional hearing on the region's heroin problem identified it as a potential site for a much-needed drug treatment center.

Five years later Nuevo Día's detoxification clinic opened its doors.

* * *

The opening of the clinic was celebrated with much fanfare. Musicians performed traditional rancheras as journalists and state politicians toured the facility, carrying with them paper plates heavy with tamales. County representatives spoke movingly about the opportunity to stem the endless tide of heroin overdose, and many recounted their own struggles with alcohol and drug addiction. A prayer...