QMJC November 2019 – They medicated me out: Social flesh and embodied citizenship in addiction treatment
Meeting: #7 November 2019
Article: Schlosser, A. (2018). ‘They medicated me out’: Social flesh and embodied citizenship in addiction treatment. Contemporary Drug Problems, 45(3), 188-207.
Allison Schlosser’s (2018) article ‘“They medicated me out”’: Social flesh and embodied citizenship in addiction treatment’ offers a nuanced and carefully articulated analysis of forms of embodiment that take shape within a residential addiction treatment service in Ohio, U.S. The article is a strong example of how qualitative research methods such as in-depth interviews and ethnographic observations allow for a rich analysis of the operations of power, embodied inter-personal relations and the consequences of careless and, at times, punitive treatment practices.
Schlosser conducted a ‘person-centred ethnography’ in a long-term residential drug treatment service named ‘Sunrise’. She undertook ethnographic fieldwork from March 2014 to December 2015 and in-depth interviews with 36 randomly selected clients. She also conducted additional participation observation with 10 clients purposively selected to balance gender, race and age. The article focusses on the stories of two women – Lola and Bev – whose experiences at Sunrise emphasise the complex relationship between gender, embodiment and agency that took shape through the treatment offered there.
Drawing on insights from Science and Technology Studies scholarship conceptualising the mutual implication of bodies and matter, Schlosser analyses how her participants’ embodied relations, subjectivities and agential capacities shape and are reshaped by treatment practices.
The article presents Sunrise as a treatment setting that imposes very tight restrictions on clients’ day-to-day activities. The service attempts to structure almost all the clients’ use of time, their interpersonal interactions and, significantly for Lola and Bev, their medication regimes. Lola and Bev, in different ways, attempt to reassert some control over these aspects of their lives. For example, the article tracks Lola’s experiences raising concerns about the medications she was prescribed at Sunrise. In particular she was troubled by the heavy sedation she experienced while in residence, an issue that proved to have important implications. This sedation made it difficult for her to participate in treatment activities, diminishing her social position in treatment, and made it difficult for her to access housing once she completed her stay. This is an especially difficult situation for Lola who had very limited material resources at her disposal. The medication regime also led to significant weight gain, a situation that undermined Lola’s sense of self-worth and identity as someone who, prior to her admission into Sunrise, was known to take pride in her appearance. In response, during the months post-treatment, Lola began to intermittently use heroin again and returned to making money as a ‘tester’ of the heroin of her former supplier: paid by him to consume the drug and assess its quality (201). Schlosser convincingly argues that this challenging set of circumstances and the significant risks they pose are co-produced by the agential restraints imposed at Sunrise:
Alienated from her treatment peers and health and social services systems, she seemed to feel like a valued member of a community in this role, gaining a sense of social inclusion […] This survival strategy may be viewed as an expression of embodied agency that draws on and reclaims the intense bodily connection Lola developed in illegal drug use, but from which she was so alienated in treatment. (201)
Bev similarly had concerns about the medications she was prescribed at Sunrise and, like Lola, was not able to have these effectively addressed while in treatment. Upon leaving, Bev attempted to have her buprenorphine and benzodiazepine doses adjusted to better treat her anxiety and withdrawal. However, after a particularly stigmatising healthcare encounter, she gave up engaging with public health institutions and began accessing benzodiazepines through illegal markets. In this way, Bev drew on her embodied knowledge of medication effects and social relations to reassert control of her life and health.
This dynamic in which unresponsive and overly-constraining treatment practices designed to limit client agency operate to push clients such as Lola and Bev into situations that expose them to risk, is a key implication of Schlosser’s article. As she argues,
These risks lay bare a central paradox: when individuals resort to underground economies to access resources and social belonging, they challenge their marginalization and simultaneously reproduce it through exposure to health risks and continued alienation from formal healthcare and social services. (202)
This is an example of conceptually ambitious empirical research with important implications for drug treatment practices and policy. Schlosser’s call for a research focus on how bodies and agential capacities are made and re-made through treatment practices is significant. Schlosser effectively demonstrates how treatment practices limiting client agency and power can inadvertently produce treatment ‘failure’ and reproduce the exposure to risk and marginalisation they are purportedly designed to reduce.
Dennis, F. (2016). Encountering ‘triggers’: Drug-body-world entanglements of injecting drug use. Contemporary Drug Problems, 43(2), 126-141.
Fomiatti, R., Moore, D. & Fraser, S. (2017). Interpellating recovery: The politics of ‘identity’ in recovery-focused treatment. International Journal of Drug Policy, 44, 174-182.
Fraser, S. (2006). The chronotope of the queue: Methadone maintenance treatment and production of time, space and subjects. International Journal of Drug Policy, 17(3), 192-202.