On the effects of cultural discourses of addiction

If you’re not one of my Facebook friends, you may not know what’s going on in my non-film-critic professional life. I’m an anthropologist, remember? So: I finished my dissertation on the effects of cultural discourses of addiction on meth-using HIV-positive men who have sex with men San Diego, received my doctorate in anthropology from UCSD in June of 2013, immediately started a post-doctoral fellowship focused on HIV prevention research at UCLA, am now finishing that, and, with luck, will be gainfully employed by someone fabulous before July. But, chances are, my readers do know that. Or not. Hard to know.

However, even if you do know that stuff, you probably haven’t had the opportunity to read my fabulous dissertation or, as I do when I get a copy of a friend’s dissertation, check to see if you’re in my acknowledgement section. I was told that it was going to be the most fun to write, and it was, since every other section involved deep thoughts. The acknowledgments just required memory and synonyms for “thanks.” After three pages1, however, I ran out of time and space, and I left a lot of people, places, and things off the list. So, an addendum was in order, but I’ll just footnote that, too, because the main reason for this post to talk about where the research went2.

And since you haven’t read my dissertation — and I doubt more than four people have actually read the whole thing — you probably don’t know exactly what I was doing all that time I lived in San Diego. It’s fabulous, but I don’t suggest you read it. Since I finished the thing, I’ve done a great deal of work on large chunks of it, transforming three of the chapters into articles. Those have all been published now, and now I’m going to give you the 411 on them3.

Survival Tactics and Strategies of Methamphetamine-Using HIV-Positive Men Who Have Sex with Men in San Diego,” PLOS ONE, September 30, 2005.

In this article, two ways that HIV-positive drug users survive under the supervision of law enforcement agencies, community health organizations, and social welfare offices are differentiated. First, strategies are long-ranging and often carefully planned, and they involve conscious utilization and manipulation of bureaucratic processes. Second, tactics are short-ranging and often haphazard, and they are used to survive on daily or weekly bases, with entrenched problems and structural solutions avoided or ignored. Data from three years of ethnographic fieldwork with 14 methamphetamine-using HIV-positive men who have sex with men in San Diego, California is used to expand upon these two categories, explaining the different, often ineffectual, ways these men accessed care, services, shelter, drugs, and companionship. This article also examines the policy implications of taking in consideration these different kinds of survival methods, arguing for intensive client-specific interventions when working with long-term addicts with multiple health problems.

Pride, Shame, and the Trouble with Trying to Be Normal,” Ethos, December, 2015.

Methamphetamine use and HIV are large and intertwined problems in American gay communities. This is particularly so in San Diego, California, where both meth and HIV have been endemic for three decades. Because meth use is associated with not just the spread of HIV and other STDs, but also with petty and violent crime, the public health and law enforcement agencies have responded with substantial, but often ineffective efforts at turning meth addicts into “normal,” “productive members of society.” In this article, I examine the effects of these processes on the subjectivities of 14 meth-using HIV+ men who have sex with men (MSM) who were the focus of person centered ethnographies I performed from 2009 to 2011. All of the participants in my study wanted to be normal, and what constituted normalcy was an American – in both the last 20th century neoliberal and “homonormative” ways – ideal of self-reliance, employment, health, marriage, and home-ownership. This desire for normalcy was not just the product of living in the United States at a particular historical moment, but also it was also influenced greatly by the men’s experiences with recovery programs, the prison system, and healthcare providers, all of which were trying to shape them into particular kinds of subjects, specifically addicts, either active or in recovery. They were taught to narrativize their addiction as moral and medical stories, and their stories tended to end with dreams of a normal future, a future free from pain, frustration, and the gaze of the apparatus. But in their struggle to make that future happen, their emotional options were limited by the anti-meth apparatus: those who failed felt profound shame, those who succeeded expressed great pride in their abilities, and those who hovered in the middle I describe as having “risky subjectivity,” the perpetual constructing and reconstructing, the perpetual struggling to become something else.

Framing Samuel See: The Moral Panic and “Double Epidemic” of Methamphetamines and HIV among Gay Men,” International Journal of Drug Policy, February, 2016.

After being arrested for violating a restraining order against his husband, on November 24, 2013, Yale professor Samuel See died while in lockup at the Union Avenue Detention Center in New Haven, Connecticut. The death received media attention around the world, with readers arguing online about whether See’s death was caused by police misconduct, as his friends and colleagues charged in interviews and during a well-publicised march and protest. When an autopsy revealed that he had died from a methamphetamine-induced heart attack, online commentary changed dramatically, with See’s many supporters rhetorically abandoning him and others describing him as a stereotype of the gay meth addict who deserved his fate. In this article, I argue that this shift in the interpretation and meaning of See’s death can be traced to the discursive structures left by the moral panic about crystal meth in the United States (1996–2008), which comprised within it a secondary moral panic about crystal meth in the gay community and its connection to the spread of HIV and a possible super-strain (2005–2008).

I’m currently revising a fourth piece for a collection of essays on syndemics.

My doctoral research led me to all sorts of places I never though I’d go. One of those places is the American corrections system, a bizarre and awful thing that is in desperate need of reform — and research. And my current work is with recently released HIV-positive MSM and transgender women who were incarcerated at the Los Angeles County Jail. But that’s another post.

  1. The research and writing of this dissertation has been the most rewarding intellectual experience of my life, and it would not have been possible without the intellectual, moral, and practical support of a community of scholars, friends, and family.

    The members of my committee provided me with the tools I needed to develop a theoretical position, formulate an ethnographic project, and perform the research, and then go about the strange process of turning all that into something resembling a book. My chair, Janis Jenkins provides me with the theories, approaches, and concerns that inspired this project. She gave me the light bulb that appeared over my head and blinked on in 2008 when I figured out what I wanted, and needed, to write about. That light bulb is still shining. Nancy Postero guided me back into the field of anthropology after 10 years away, giving me a political and moral understanding of the discipline that I had not appreciated or understood. Suzanne Brenner, over many hours in the homes of many of San Diego’s gay couples, taught me how to do fieldwork and to think like an ethnographer. Steve Parish helped me to transform my journalistic skills into anthropological methods, and his encouragement of this project and my work helped me to believe that I might actually be doing something worthwhile.

    If I had not met Tom Patterson, I doubt I would have done this particular project, and I also doubt that I would have had such wonderful, enlightening conversations about its specificities, oddities, and importance. And finally, the last addition to my committee, Norman Bryson, will always be the teacher who now 20 years ago assigned me Foucault for the first time, changing not only my interpretation of art and literature at the time, but eventually my entire understanding of the world and how it works. It is wonderful that I am able to end my formal academic career with the person who helped spark it two decades ago.

    Several other professors have been very important. Two former committee members provides needed assistance early on. Elisa Sobo helped me to understand the massive literature on the anthropology of AIDS, while Meg Wesling gave much needed bureaucratic help at the most important moment. Keith McNeil, who was one of my master’s thesis advisers, was the person who introduced me to psychological anthropology, which, honestly and wonderfully, changed my life. I also filled my intellectual toolbox in the particularly enlightening classes of Elana Zilberg, Joe Hankins, and Tom Csordas at UCSD, as well as in classes at Harvard taught by Byron Good, Arthur Kleinman, Salmaan Keshavjee, Kaila Compton, and William Fisher.

    Of course, if not for my junior colleagues, in the Department of Anthropology, in other UCSD departments, and at other institutions, I would have been lost. In particular, I single out the other medical and psychological anthropology students Whitney Duncan, Charlotte van den Hout, Allen Tran, Bridget Haas, and Jess Novak. The advice of Eli Elinoff (particularly), Julia Klimova, and Erica Fontana in the department’s dissertation practicum was invaluable. I do not think I would have survived graduate school without the love, humor, and friendship, and brilliant scholarship of Jason Farr, Eun Jung Park, and Marion Wilson. Adia Benton has never wavered in her support of me and my work since we met in a panel at the meetings of the American Anthropology Association in 2008. And Timothy McCajor Hall has encouraged me since 1993. Alison Miller, my dissertation coach, taught me how to work.

    Edward De Anda, my research assistant during a key 18 months of the project and now a PhD student in clinical psychology, provided needed help transcribing interviews, managing the flood of research, and providing a soundboard for me initial analyses. Later in the process, four of my best students at UCSD provided needed help: David Lam, Timothy Sargis, Sairah Khan, and Janelle Brown. Thank you.

    None of this would have happened without my family. My brother Hendrik has been on the other side of some of my most profound discussions about addiction. My ex-husband Rob Williams encouraged and joined me for the first six years of the process. And my parents, Hendrik and Sarah Gideonse, not only made it possible for me to do the research, but they also raised me to be curious, moral, loving, and honest. I did it by watching you.

    And finally, I owe a debt of gratitude to my informants, from the men in my central sample who told me their life stories to the people in the apparatus who gave me their time and energy when they certainly did not have to. This has been edited for typos, style, and (slightly) content.

  2.  Here’s to the friends, acquaintances, and fellow travelers who were supportive of the long and occasionally torturous process:

    The staffs of Subterranean (especially), Twiggs, Peet’s, Filter, and various Starbucks who never kicked me or any dissertating grad student out even though we sucked the WiFi and didn’t order enough (though I think I did, since I felt guilty);

    all of other grad students who, at various times, joined me at these cafes and similar places, particularly Tom Waidzunas, Yumi Pak, Julie Lee, and Ted Falk;

    non-academic friends who joined me at cafes and/or commiserated over beers, particularly Lance Criley, Brock Saucier, Jessica Jollet, Andrew Printer, and Justin Hudnall;

    the great people at Family Health Centers who became friends, especially Brian Gorman, Luis Salazar, Kevin O’Rourke, Nicholas Lagunas, and Iris Kristoff;

    all of the various musical acts who, unbeknownst to them, got me through the anxiety of studying, researching, and writing, most importantly Grace Jones, Kraftwerk, Dolly Parton, Johnny Cash, Fleet Foxes, Lady Gaga, Britney Spears, TV on the Radio, The National, Vampire Weekend, and The Scissor Sisters;

    all of the TV shows that I used to distract or de-stress, including but not limited to American Idol, Desperate Housewives, Battlestar Galactica, The L Word, and especially Buffy the Vampire Slayer, an episode of which I’d watch every night after doing fieldwork to help me deal with what I’d seen and been told (since supernatural, comedic horror is better than our natural, pedantic stuff);

    the food and drink I used for comfort, such as peanut butter, overpriced Greek yogurt, tortilla chips, cheese (glorious cheese), and the stuff Charles Shaw is branded with that is supposedly “wine”;

    and finally, the cats I lived with: dearly departed Hermia and still-here Jack and Betsy, the two most constant friends I’ve had. (Okay, the cats have to be constant, because they’re trapped in my apartment and I feed them, but I still appreciate that they have never turned on me and, amazingly, usually treat me as a friend instead of a jailer.)

    I’d like to not thank the people I met who mocked graduate schooling, who claimed that I couldn’t have found anything useful without statistics, or who walked away in the middle of conversations about what I studied. Anti-intellectuals are boring, but more importantly they’re dangerous.

  3. The links go to my Academia.edu page where you can download the articles for free. Which is a good thing.

My World AIDS Day post: HIV, the Internet, and identity in San Diego.

This is my post for Bloggers Unite for World AIDS Day. It’s sponsored by AIDS.gov and BlogCatalog. A bunch of folks around the world are blogging about HIV and AIDS. My addition is a paper I gave last week in San Francisco about HIV, the Internet, and identity in San Diego.

If you were following my Twitters and/or my Facebook updates, you know that the weekend before Thanksgiving I was in San Francisco for the American Anthropology Association’s annual meetings. It is always wonderful to be in San Francisco, but I was so excited to be there, I tried to do too much, see too many people, have too much fun, and do what I was there to do: attend the darn meetings. And I ended up tired and cranky a lot of the time. Very tired. Very cranky. And then, on Thanksgiving morning, I woke up with a karma-rific cold. Still, I got one the best haicuts of my life from Joe, had an amazing dinner with Tom, had a couple beers with Mike, had an awesome dinner with Chia-Ning, went dancing here with Kevin, had several beers with a cheerful Jeff and several more with my fellow former New Yorker John. And I got to hang out with my sister-in-law Laura, who was also in town for a conference and with whom I shared a couple hotels rooms. (I stayed in three hotels in San Francisco that week. The Marriott is over-priced but damn nice. The Carlton is adorable and delightful. The Pickwick is a pit of despair.) Oh, yeah. And I did some anthropology-related things as well. I didn’t go to as many panels as I should have, but I networked up the wazoo, and ultimately, that will probably be more worthwhile.

And I gave a paper at a panel I organized with my friend Cage. The panel was called “Identities in the Clinic: conflicts, tensions, and critiques of self-concepts.” Here is the panel abstract:

Since Mauss’s essay on the person and Hallowell’s analysis of the self in its behavioral environment, anthropologists have attended to various ways in which certain kinds of social statuses and self-concepts organize social structure, perception, motivation, and action. In recent years, however, despite a new proliferation of articles on hybrid, fluid, or cyborg identities, and the play and tension of subaltern identities, much of this analysis remains at the level of the political and symbolic. The papers in this panel seek to ground and critique current ideas of identity and self, to elucidate the processes of identity as commitment to certain ways of being and certain moral ideals, as well as certain ways of perceiving, attributing, and interpreting signs of health, illness, sentiment, and morality, particularly as applied to issues of mental and bodily health, through explicitly psychological models. The papers herein examine the ways in which patients and health care providers negotiate conflicting identities: as agents of the state, as “systems based providers”, as documented/undocumented, as members of sexual or ethnic minorities, as simultaneously physician and scientist, or as a person with an illness negotiating multiple epistemological orientations in religious and cultural identities.

Could you be more excited? I didn’t think so.

For my World AIDS Days Bloggers Unite post, I’ve pasted the paper below the jump. It’s very much a working paper, and it should be treated as such. Continue…

Me, meth

I’ve been meaning to update the five or six people who still read my blog on how my studies are going, since, well, the whole reason I’m here in Blandiego is the studying. But, actually, no, I haven’t been studying. And no, I haven’t been doing meth. I’ve been doing all sorts of other things, like teaching and obsessing over gay marriage and untangling myself from the absurd red tape caused by an ill-fated attempt to take a class cross-registered at UC-Irvine. (Irvine use punched cards in the registrar’s office. Still. Really. When I dropped the class I was cc-ed — for realz — on five emails from various admins at two campuses, because no one has figured out how to use the Interweb to connect the two schools.) I’ve also been collecting all sorts of fun stuff about crystal meth, because that’s what I’ve switched my focus to. Yeah — I came here to study assimilation and sexuality on the US-Mexican border and now I will be studying the gay meth “epidemic” in California.

This is what happened: I went to check in with one of my committee members. I had planned on working on a study on HIV-prevention among MSMs in Tijuana. I had spent two and half years studying Spanish and US-Mexican border issues (and theory), and I wrote my Master’s thesis on “Hybridity as Cultural Capital on the US/Mexican Border.” (Wanna read it? I’ll email it to you. And then I will list you in my Outlook contacts in the “masochist” category. Not that I have a category with that name. Really.) So, I was ready, more or less, to do a big ethnographic project of the such. But my committee member told me that the project that I was going to join and study (I was going to study the study, as it were) didn’t exist yet, for a host of reasons. But before I got to freak out, I was offered a number of other projects that I could hook up with, and I jumped on a large study of HIV+ gay men who use crystal meth.

I guess the questions would be: Why did I jump on this? Well, there’s one pathetic reason: My Spanish sucks and will suck for years — I’m convinced I have cognitive deficiency when it comes to languages — and so I’ll never be able to do the sort of psychodynamic interviewing in Spanish that I wanted to do. I could have done it with a translator, which had been offered, but it would have been a barrier/filter that I didn’t want to have to use, let alone totally rely on.

[youtube:http://www.youtube.com/watch?v=tG5odfNmzqM]

Then there’s the not-at-all pathetic reason: The meth situation in California’s gay communities is … gee, what’s the right word? Explosive. Dynamic. Epidemic. Increasing. Contagious. Confusing. Bizarre. Sexy. Dangerous. And it’s on the tips of everyone’s tongues, gay and straight. This is partly because of the recent, massive “Me Not Meth” campaign from the California Methamphetamine Initiative, the anti-meth arm of the California Department of Alcohol and Drug Programs. There are billboards all over the gay neighborhoods of California. There are ads on the sides of buses and in the Bay Area subways. There are 30-second TV spots running during, heh, “Desperate Housewives.” And I haven’t seen such a wide-spread concerted public health effort in gay bars since the early 90s: there are posters in every gay bar I’ve visited in the last month, and many of them also have “I lost ME to METH” drink coasters, too. The ads are the topic of conversation everywhere, and not always for the reason they’re meant to be. The recovering addicts in the ads are, um, kinda hot. As a friend said to me last weekend, “If they want people to stop using meth they should use guys who aren’t so attractive.” The man on the coaster (above) is especially cute; he looks like a cross between Jake Gyllenhall and Ryan Gosling. Yum!

 

Some people are simply pissed off by the campaign because they think that it unfairly singles out gay men, and this will, supposedly, lead the gays to be further stigmatized. In typical fashion, San Diego’s own Gay and Lesbian Times led the charge here:

Now, this is a necessary campaign – meth addiction is an epidemic in the gay community, and, the fact is, meth use is a risk factor in the spread of HIV/AIDS. It eliminates inhibitions, alters judgment, wreaks havoc on one’s personal and professional lives, and has dire health implications.

Another fact to consider, though: meth addiction doesn’t discriminate. It doesn’t single out a gender, race or community – but this ad campaign does.

The important question that must be asked is: does this ad campaign do more harm than good? For the vast majority of heterosexual TV viewers, what message does the campaign send about our community?

Again, it’s no secret: meth is a problem in the gay community, as much as it’s a problem in the straight community, the Latino community, the Native American community, the black community – the risks are as monumental for us all.

But, the well-intended ads, inadvertently we think, send a mixed message; one, that meth abuse is a problem exclusively in the gay community; and two, that the gay community is characterized by drug use and HIV/AIDS.

Why do I use the word “typical”? Because the GLT tends to get their facts wrong, and this is just another example. Here’s the Los Angeles Times on March 14:

The drug, commonly known as “crystal” or “tina,” has been a popular party drug in gay circles since the 1990s. A statewide survey, also released Thursday, found that crystal meth use was 11 times more common among gay men than in the California population overall. Fifty-five percent of 549 gay and bisexual men surveyed said they had used the drug, compared with 5% of the general population.

So, um, meth is not “as much as [of] a problem” in the gay community as the straight community. It’s 11 times worse. That is 1100% worse, if you want to play with the numbers. The GLT is so embarrassing. There are some problems with the “Me Not Meth,” but they aren’t in their focus on gay men. At all.

Anyway, I’m very excited about the shift in my project, and I’m excited about getting my qualifying done. That involves a lot of reading and writing, and then I can write my proposal, which will include, in some form, the following paragraph:

… the governmentality of public health helps to construct gay men as, what I call, risky subjects: neoliberal and sanitary subjects, sexual citizens with a political ethos that connects gendered behavior and subaltern sexuality to a moral regime that promotes individualism and responsibility within, ironically, a culture of hedonism. Since its appearance in the early 1980s, AIDS has been at the center of contestations over biopower, as those who might have, do have, and will probably contract the disease are disciplined, punished, and quarantined. Public health—as well as its surrogates in private healthcare, the ever-increasing number of activist NGOs, and aligned law enforcement agencies—has been charged with not just the modification of behavior, but also, and perhaps more importantly, the construction of subjects. These subjects are not just healthy citizens, healthy Americans, but also productive citizens, responsible, happy, and normal. But what sorts of subjectivities are actually produced? And how? People who are “at risk” for HIV-infection, whether they are men who have sex with men, IV drug and crystal meth users, sex workers, hemophiliacs, or anyone from a disease-ravaged nation, are made into risky subjects with hypercognized biology, bodies, and behaviors. But this is not necessarily (or not always) a negative form of state oppression, despite the tenor of much of the literature on governmentality, the modern form of statecraft that is probably most pronounced in processes of public health. Rather, the history of AIDS shows that both resistance to and collaboration with the governmental public health project has resulted in a slow and steady pushing of the subjected into the subjectors. The public health project is subverted and mutated as the HIV-positive become doctors, gay academics devote their research to HIV and AIDS, and activists, recovering addicts, and former sex workers are professionalized as employees of NGOs and state agencies. Nevertheless, there is no doubt that that there are deeply negative effects of becoming a risky subject, for the mental health ramifications are as potentially insidious as they are deeply under-recognized.

Ya know, in case you were wondering about my theoretical perspective on the whole thing.