Righteous Dopefiend

“Our approach […] is premised on anthropology’s tenet of cultural relativism, which strategically suspends moral judgment in order to understand and appreciate the diverse logics of social and cultural practices that, at first sight, often evoke righteous responses and prevent analytical self-reflection.”

One of the key foundations of anthropology is the concept of cultural relativism: that one’s concepts of morality hold no bearing outside of one’s cultural context. The Introduction explains why this is important for readers unfamiliar with anthropology, particularly as they read about the actions that interlocutors take and the decisions they make within a socio-cultural context that is likely very different from their own. The book prepares readers to exercise non-judgment by calling on them to practice critical self-reflection while considering the mindset of the book’s subjects.

“Through symbolic violence, inequalities are made to appear commonsensical, and they reproduce themselves preconsciously in the ontological categories shared within classes and within social groups in any given society. Symbolic violence is an especially useful concept for critiquing homelessness in the United States because most people (including the Edgewater homeless themselves) considered drug use in poverty to be caused by personal character flaws or sinful behavior. We hope to deconstruct the generalized misrecognition of the ways everyday, intimate, and structural violence generate and are legitimized by symbolic violence.”

French philosopher Pierre Bourdieu’s concept of symbolic violence contextualizes the book’s approach to the Edgewater Boulevard population. This work’s authors rely on Bourdieu’s theory to explain how the people in Edgewater came to live their hard lives: Observers often misconstrue who holds power, ascribing agency to individual actors and ignoring the dominance of the wider institutions and systems that limit their choices.

“The ‘coolness’ of African-American street culture does not translate into economic and political power in the United States. On the contrary, blackness and expressions of hip-hop or working-class street culture exclude individuals from access to upward mobility in the corporate economy.”

Race and ethnicity play out differently in a lower-status community than when trying to climb the corporate ladder for work or engage with politics. As part of its exploration of The Racialization of Poverty, Homelessness, and Addiction, the book also differentiates between the role race plays in interpersonal interactions within one’s community versus within the systems and institutions that encompass these interpersonal relationships.

“What we call the ethnic components to habitus have emerged in the United States out of a history of slavery, racism, and socioeconomic inequality. They manifest themselves through everyday practices that enforce social hierarchies and constrain the life choices of larger categories of vulnerable people, who become identified in an essentialized manner as ‘races’ or ‘cultural groups.’ Ethnic components to habitus thereby become a strategic cog in the logic of symbolic violence that legitimizes and administers ethnic hierarchy, fuels racism, and obscures economic inequality.”

The authors explain their understanding of how ethnicity plays into the concept of habitus, prompting readers to question how natural categories of race and ethnicity really are and where assumptions based on race or cultural groups are rooted. This topic touches on the different layers of violence the book discusses as well, because race and ethnicity play into the kind of violence the Edgewater Boulevard population experiences.

“A theory of abuse, however, that engages the interface of psycho-affective turmoil with structural and institutional forces such as historically ingrained inequalities around gender, class, ethnicity, family arrangements, and the provision of social services to vulnerable children is useful for understanding why it might feel empowering to Tina to make men pay for her body. ‘My body is precious to me. I am not going to give it up to nobody. And I a beautiful lady.’ Arguably, by selling her body, Tina obtained a sense of control over the multiple sexual exploitation she was subjected to as a child and (continued to suffer later in life).”

This passage is key to the work’s consideration of Gender and Sexuality in Poverty, Homelessness, and Addiction. The authors explain that Tina’s engagement in sex work is a reasonable action made by a rational actor, based on her context. The control that she gains from earning an income makes sense economically and fits her socio-cultural worldview.

“Interpersonal flare-ups like this one between otherwise affectionate running partners and lovers reminded us that in gray zones, aggression is the most effective means of asserting rights. Violence is normalized as ethical. In Tina and Carter’s case, violence also deepened their romantic bond.”

A violent altercation between Tina and Carter connects the interpersonal violence they engage in to the ways they have been socialized. For people with their backgrounds and social contexts, interpersonal violence is normalized as an ethical way to assert dominance and control in domestic situations. Edgewater residents like Tina and Carter enact violence to reproduce traditional gender roles—particularly their understanding of the dynamics of a relationship between a man and a woman in a romantic relationship.

“We realized that cooperating to purchase bags is not simply a pragmatic, economic, or logistical necessity; it is the basis for sociality and establishes the boundaries of networks that provide companionship and also facilitate material survival.”

Edgewater Boulevard culture differs from mainstream culture in a variety of ways. Economically, it differs from the mainstream market economy by being a moral economy, where people trade in generosity and capacity to share with one another. Understanding this difference is important before considering public health policy; for instance, programs aiming to prevent needle sharing interfere with the sharing that is vital to the moral economy and well-being of unhoused people using intravenous drugs.

“Combining Bourdieu’s critique of symbolic violence with Foucault’s insight on the knowledge/power nexus suggests that the harm reduction movement’s well-intentioned hepatitis C blood-testing and counseling initiative inadvertently created a dynamic of unproductive self-blame among the Edgewater homeless, which contributed to the conventional misrecognition of the relationship between power and individual self control.”

Public health programming that tested Edgewater residents for Hepatitis C aimed to teach them best practices to reduce harm. In reality, this initiative only told the population that most of them had Hepatitis C and how they got it—not useful or relevant preventative information. The unintentional effect was to shift blame onto the individuals themselves—a hidden way institutions enact violence, according to the book’s authors.

“Poor African-American boys were being formed into professional outlaws before they began to use drugs, whereas poor whites embarked on criminal careers later in life, after their drug use had spun out of control. This historical, institutionalized ethnic pattern from the 1970s was a crucial generative force shaping the contrasting dopefiend habituses of outlaw versus outcast that became visibly racialized on Edgewater Boulevard in the 2000s.”

Economic mobility is a key factor when considering what mainstream society regards as illegal activity—within a context where legitimate work is hard to find, exploitative, or discriminatory based on race, it makes sense for rational actors to take on and valorize “outlaw” behavior and identity. Historical context further accounts for why the interlocutors’ intersection of drug use and employment differs by race.

“Following the logic of symbolic violence, involvement in illegal activities is usually considered to be a personal choice that reveals an individual’s moral defects. The structural political-economic forces that are in fact at work operate ‘invisibly’ at a more subtle, long-term, and incremental level of habitus formation. Drug use, crime, and homelessness, therefore, are widely suspected to be evidence of laziness, lack of intelligence, biogenetic disability, or inadequate impulse control.”

Black interlocutors in the Edgewater Boulevard community end up doing more illicit activities to make money for straightforward reasons of access; when their socio-cultural context is taken into account, their decisions to take up illegal work are rational rather than indicative of moral failure. The same goes for racialized violence, which constrains the choices of Black interlocutors while wider society blames them for “moral defects.”

“The structural adjustments caused by globalization were rendered even more disruptive by the historical shift in the US mode of governance away from rehabilitative social service provision towards punitive containment […] Economically obsolete, members of the lumpen become unable or unwilling to engage in disciplined productive labor. They do not even form part of what Marx called ‘the reserve army of the unemployed’ that factory owners draw upon to undermine unions in lower wages.”

The book uses Marx’s concept of lumpen to explore the economic context of the Edgewater Boulevard population. Most of the interlocutors came of age during a time of a huge economic shift that led to lost household economic stability. Here, the authors stress the fact that their interlocutors are not simply unemployed or in between work; they are chronically unemployed because neoliberal ideals have prompted policymakers to focus less on social services and preventative care in favor of punitive methods of “handling” people in the lumpen class.

“The African Americans rarely discussed employment spontaneously or sought jobs during the years we knew them. Nevertheless, when we collected their work histories, they spoke positively about past involvement in the legal labor market. Their nostalgic reminiscences provide additional evidence that their celebration of an outlaw persona, which proudly rejected subordination and exploitation and the labor market, was not a personal choice rather it was imposed on them by a legacy of exclusion from legal employment.”

The psychological and socio-cultural impact of a discriminatory job market and the criminalization of poverty disproportionately affect communities of color. The authors realize that even though nearly all speak positively about the legal work they’ve done, Black interlocutors celebrate the outlaw persona more than white interlocutors. This is because Black interlocutors face a reality that regularly excludes them from employment that dominant society considers legitimate.

“Understanding him (Sonny) or any of the homeless on Edgewater Boulevard and absolute moral categories, such as worthy worker, or thief, or xenophobic dopefiend, overstates the parameters for individual agency and obscures structural forces Sonny’s predicament is framed by a restructured global economy, institutionalized racism, and shredded welfare safety net, gentrification accompanied by a speculative real-estate market, and draconian drug laws.”

Chapter 5 zooms in on the stigmatizing categories that one interlocutor may be placed in by mainstream society. These “absolute moral categories” reflect American culture’s valorization of individualism; many people believe they live in a meritocracy, thus allowing them to view Edgewater residents as inherently inferior. However, the authors point out that Sonny’s “immoral” behavior is the result of his choices being constrained by many factors entirely outside of his control. None of these can be addressed if all the blame for the harm he causes to himself and others is treated as though it starts and ends with him.

“Arguably, the levels of bodily pain (cold, hunger, abscesses, exhaustion) that the Edgewater homeless endure daily as drug users can be interpreted as self-punishment from unresolved childhood trauma. In many cases, abandoning children for homeless heroin injection and crack smoking was less toxic than attempting to maintain the patriarchal nuclear family ties that perpetuate domestic gray zones.”

Interlocutors have fraught relationships with their families, and the interpersonal violence that is commonplace in many interlocutors’ homes is rooted in patriarchal nuclear family values. Many of the men in these homes cling to this model because they are unable to provide the income that their family needs; they enact violence against family members to have some other way of assuming patriarchal power. Their marginalized identities make it harder to achieve said values, so interlocutors can only break this cycle of violence by going on the streets.

“Our theory of lumpen abuse goes beyond the individualizing psychological frame to link psycho-affective experiences—including those that express themselves in oedipal frustrations—to political-economic and cultural forces as well as to gender power relations. Violence in Sal’s account is not simply sociopathy or a universalized masculine drive for domination. It is mindful, targeted, effective, and ethical within its own logic.”

A peripheral figure who brags about beating both his son and his wife exemplifies a common behavior among the book’s male interlocutors; here, the authors consider what makes for a worldview in which physical violence against one’s child and wife is believed to be reasonable. The passage adds another layer to the discussion of socio-cultural, political, and economic dynamics among the Edgewater population by providing an illustration of how this majority-male context enacts gender power dynamics.

“If lumpen is a subjectivity as much as a class category, it can be understood as emerging out of a negative relationship both to the mode of production and to biopower. We might expect, consequently, that lumpenized populations would have more transgressive ways of being in the world than normatively disciplined citizens for whom biopower is generally productive and rewarding.”

Some men in the Edgewater population engage in homosocial relationships despite the rampant anti-gay bias interlocutors express. Here, the authors consider how the two can co-exist in terms of biopower and lumpen subjectivities: Because the lumpen exist on the very edges of society, societal pressures such as heterosexuality—or even the binary of gay versus straight identity—hold less sway.

“This institutional budget crisis for social services for the poor occurred in the context of one of the most rapid accumulations of regional and personal wealth in US history. It had a predictable impact on Hank and Petey.”

As Hank and Petey bounce between intensive care units and the streets, the book explores their problem on an institutional level: Law enforcement exacerbates the suffering of the Edgewater population while social services barely scrape by, unable to meet the population’s basic needs. During the dot-com economic boom, neoliberal policies allowed wealth to be increasingly concentrated into fewer hands while slashing spending on social services that would support those pushed out by the gentrification of cities like San Francisco.

“Initially, Tina made no effort to learn how to use a needle and became totally dependent on Carter. Having Carter inject her was a way of expressing their romantic intimacy and further reinforced Carter’s assumed responsibility to generate enough income for her new heroin habit (as opposed to her previous crack habit).”

The rituals surrounding daily drug use can reinforce traditional gender roles and embody intimacy between users. Here, the model of a wife keeping the home while the husband earns an income is altered to fit Carter and Tina’s circumstances. Wider societal ideals do eventually trickle down to the lumpen at the edges of society, altered to fit their own worldviews and the realities of life on the street.

“Without substantial institutional resources, it is difficult for long-term chronic users to figure out how to pass the time of day. They have to construct a new personal sense of meaning and dignity. Instead, they often fall back on their more familiar and persuasive righteous dopefiend ways of being in the world.”

Tina exits her detox program, only to be dropped back off at a women’s shelter she knows has poor conditions and readily available drugs. Becoming sober is so challenging as to be nearly impossible when a person is put right back into a context where they previously used drugs, among people they used drugs with. In this scenario, individuals do violence to themselves, but within the context of broader institutional structures that enable it. The detox program and nearby long-term residential programs have so little funding that they can’t take any more people, as federal and state governments prioritize social services less and less.

“Biomedical science declares methadone to be a medicine, but contrary discourses of law enforcement, health fitness, and moral and religious abstinence consider methadone to be a dangerous and immoral drug.”

Cultural values, economics, politics, and science can be at odds with one another, complicating the structures that impact marginalized people. For instance, drug addiction carries heavy social stigma, revealing how moral judgments stemming from dominant cultural values place additional burdens on marginalized communities. The authors stress that it is important to understand the morality of an action within its context rather than from an ethnocentric perspective.

“None of the Edgewater homeless lasted longer than two weeks on the short-term detox programs because the rapid tapering of the dose caused severe withdrawal symptoms. Although the relapses were pharmacologically predictable and represent an obvious institutional deficiency in the treatment modality, these failures became yet another forum for symbolic violence that encouraged vulnerable individuals to blame themselves for their lack of willpower.”

Chapter 9 illustrates the divide between biomedical interventions and the lived experiences of interlocutors navigating homelessness and addiction, describing a treatment model that sets people with addictions up for failure in a society that blames them for their condition and their failed attempts at overcoming it. This helps readers better understand coping mechanisms like claiming one’s “dopefiend” identity with pride—it is more palatable for interlocutors to believe they had the agency to choose it.

“Foucault’s concept of governmentality allows us to construe the Swiss heroin prescription program as an example of biopower controlling and redefining pathologized individuals via medicalization rather than criminalization. This insight explains the increased docility of former outlaw addicts as they morph into therapy-seeking patients on the path to sobriety when provided with legal heroin.”

A program in Switzerland prescribed heroin to people with addictions to avoid withdrawal and then allowed them to reintegrate into society. As a result, more people recovered from their addictions and were less likely to engage in illegal activities for money or need emergency intensive care. This shows that the theoretical framework of this book has been practically applied and that such models have yielded much better results than the American approach.

“All sick people, not just the homeless, would benefit if doctors are trained to engage practically with the social dimension affecting the health of their patients. Piecemeal attempts to teach ‘cultural competence in medicine’ as add-ons to scientific training exacerbate the problem (see Good et al. 2002 for a critique). Framing the problem as ‘cultural’ also scares the political-economic constraints that deform the provision of medical care (see Stonington and Holmes 2006, special issue of PLoS Medicine on social medicine).”

The book’s conclusion offers an example of how the authors want their research to be applied. It also problematizes attempts to teach cultural competence, which is frequently linked to race and ethnicity, because they view the use of the term “culture” to be too limiting in explaining the wider societal and systematic barriers to well-being that their interlocutors face.