I actually had the pleasure of reading this book for the second time for this class; the first being in a medical anthropology course during my junior year. I compared my notes from both times and found that themes of responsibility and subjectivity came to the forefront each time, however, the latter took on a new sense of importance this time around. Responsibility, of course, was a topic that I also connected to our readings on midwifery in Mexico. In the same way that the sources of responsibility were obscured in terms of maternal mortality, heroin addicts assume full responsibility for their recovery after they have received the resources offered by the government. Moral judgments then follow, portraying the addict as either a “good” or “bad” patient, a “good” or “bad” citizen. By removing from the focus the structural and historical factors that facilitate the continuance of substance dependence, the addict becomes the point of scrutiny and he alone bears the responsibility of the trauma that came before him.
What I found interesting though, during the second reading of this book was this particular quote and its implications: “forms of governance become forces for the creation of new forms of subjectivity” (8) Subjectivity, as described by Sherry Ortner, is “the ensemble of modes of perception, affect, thought, desire, fear, and so forth that animate acting subjects.”(Ortner 2005; 31) It is through subjectivity that an individual’s agency is altered by the social structures that their bodies exist under. For example, the punitive approach assigns moral judgments to the body of the addict, suggesting that an internal change in will or virtue is needed. However, the medicalization of drug abuse assigns the body with a physiological affliction, suggesting that recovery is not completely achieved through choice. Subjectivity, though, is shifted depending on the way in which the body is portrayed. Perceptions (both from the outsider’s perspective and the addict’s) of the addict’s body take new forms depending upon the governance of that body. Emotions are embedded in both of these realities that in turn impact the decisions made for the addict’s body. The power of perception is given to the governing body which then fuels disparity when handled incorrectly.
These two themes go hand in hand, however, I was amazed to see how the social manifests itself into the emotional and physiological worlds of individuals. I appreciated how Garcia focused on the experiential facets of heroin addiction and connects these emotions to the historical and economic trauma experienced by this demographic from colonialization to contemporary inequality.