The Pastoral Clinic: Addiction and Dispossession along the Rio Grande by Angela Garcia is an ethnographic study of northern New Mexico’s Española Valley. Garcia shares her experiences working in a heroin addiction clinic called Nuevo Día while researching the connections between land, history, and experience. Home to the highest rates of heroin use in the United States, the Española Valley offers a unique lens to study how drug addiction is informed by institutional treatment and cultural factors. Garcia uses storytelling and data to offer a new lens on addiction. Her work dismantles language and narratives developed by medical and criminal justice fields, suggesting that these factors help shape individual identity. The Pastoral Clinic won the Victor Turner Prize in Ethnographic Writing by the Society for Humanistic Anthropology and the Exceptional First Book Award by PEN Center USA. Angela Garcia is an Associate Professor of Anthropology at Stanford University.

This guide utilizes the 2010 paperback edition, published by the University of California Press.

Content Warning: The source material contains graphic descriptions of drug use, drug overdose, physical and sexual abuse, and suicide.

Summary

When anthropologist Angela Garcia returned to New Mexico to study heroin addiction in 2004, she wanted to understand the role of religion in addiction recovery and community support. However, she had difficulty gaining access to religious spaces designed to help individuals with drug addiction. Nuevo Día, the only clinic for heroin addiction in the region, offered her a job. This gave her the opportunity to record the lives of patients from an emic perspective—an insider point of view.

Garcia’s work examines multiple aspects of heroin addiction and its relationship to grief, community, economic hardship, culture, and kinship. By doing so, the researcher emphasizes that addiction is not an isolated problem; instead, it is symptomatic of myriad contextual factors that interlock. The systematic institutionalization of addiction recovery further complicates the problem by ignoring these contextual factors and trapping individuals in a patient-prisoner cycle. Garcia also explores how the historical stripping of land rights and an emphasis on the pastoral—art that idealizes rural life—create a contradiction of experience for Hispanic and Latinx families in the Española Valley. The work focuses on three central themes: The Connection Between Land, Loss, and Experience; The Institutional Shaping of Identity; and the Critique of Conventional Approaches to Addiction Treatment.

In the first chapter, Garcia explores the daily life of her work at the clinic and details the vulnerability of the patient-prisoner limbo. When individuals enter Nuevo Día, they occupy both identities. They must do the hard work of detox and recovery while understanding that what waits for them outside of rehabilitation is the exact framework that led them to addiction in the first place. Garcia argues that the loss of land grants in New Mexico served as a catalyst for an unending cycle of grief and dispossession. The story of John, a patient at the clinic where Garcia works, highlights the connection between space and experience. A blackout during her first shift at the clinic also leaves Garcia shaken and forces her to confront her own and her patients' vulnerability.

In Chapter 2, Garcia utilizes the story of a patient named Alma to examine how the loss of land and individual loss interweave and inform one another. The researcher argues that these complex webs of loss provide a foundation for melancholy, which opens a door for heroin use. The language of drug addiction and contemporary approaches to recovery perpetuate the idea that patients will inevitably return to drug use in the future. The constant reminder of an individual’s loss and the addiction narrative that implies there is no escape combine to cause recidivism—or relapse—and cultural mourning.

Chapter 3 narrows the focus on familial experiences of drug use, especially among female relationships. Garcia examines how social and economic factors contribute to intergenerational drug use. Families can be spaces within which individuals share in drug use and receive care. By looking at two mother-daughter examples of intergenerational drug use, Garcia questions the accepted idea that drug addiction is a condition of isolation. The sharing of drugs among family members leads to both guilt and liberation. In her examples, the mothers feel shame for introducing and/or sharing drugs with their children, but they also feel relieved that they no longer need to hide or downplay their own addictions.

In Chapter 4, Garcia looks specifically at overdose as a mechanism for death by suicide. She challenges conventional understandings of overdose as accidental and uses narratives to examine overdose as an extension of grief and melancholy. While patients may not use the term “suicide,” they share with the researcher that they intentionally choose to use more drugs than they should, often after feeling a deep sense of loss and depression. Garcia proposes that the institutional structures that are in place for heroin addiction ensure the isolation of individuals who use heroin, disconnecting them from community and belonging.

Chapter 5 details further research occurring two years after Garcia’s initial study. She returns to New Mexico after Nuevo Día ceases treatment operations and discusses how its shutdown is indicative of larger structural changes and economic processes. Garcia visits a woman who runs a detoxification clinic out of her home, attempting to fill the needs of her underserved community. The failure of government institutions to provide comprehensive and centralized care invites more danger as patients are left to seek alternatives for treatment or feel as though there is no hope for recovery.

In her conclusion, Garcia returns once more to Nuevo Día. While it no longer provides medical care to people with addiction, it still provides support for individuals with heroin addiction in the region. Now a land-based recovery program, patients undertake growing and planting crops, including an herb garden and a space to grow plants of their choosing. The new approach causes Garcia to think once more about the connection between land and experience, wondering if there is a way to harness and recapture cultural space for recovery.