48 pages • 1 hour read
Angela GarciaThe Pastoral Clinic: Addiction and Dispossession along the Rio Grande
Angela GarciaNonfiction | Book | Adult | Published in 2010A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapter 4Chapter Summaries & Analyses
Chapter 4 Summary: “Suicide as a Form of Life”
Garcia opens the chapter with three descriptions of suicide. The first is a firsthand account of a drug overdose, recounted by a patient who was saved at a hospital. She describes the experience as getting lost in a serene field of snow. The second account is from a medical professional, who describes the clinical details of drug overdose. The third is told from the perspective of a mother who finds her daughter after she overdosed. Garcia proposes that these three accounts reveal that suicide and overdose are as complex as life itself. She suggests that death by suicide has something to offer about the nature of life. While she discusses this idea, Garcia maintains awareness of her role as an anthropologist and the implications of what it means to discuss suicide as a type of life.
Drug-related suicide is a common part of the heroin addiction context, but it was not always viewed this way. A nurse and mental health professional tells Garcia that, for a long time, overdoses were almost always treated as accidental. After asking patients questions, the nurse soon learned that there was a story to tell about how patients used heroin and other hard drugs to die by suicide, even if they did not name their actions as “suicide” explicitly. The percentage of women who experience heroin overdose is three times higher than men, and more than half of women who overdose admit that they were seeking death in their drug use.
Sarah, a woman who visits the women’s recovery group at Nuevo Día, provides Garcia with an understanding of what may drive someone to this point. The other women in the group are judgmental of Sarah, who dresses provocatively, takes great care with her appearance, and says little during group time. Garcia learns that Sarah has multiple sclerosis, which she hides from the women in the group, as well as her boyfriend. However, her MS symptoms are beginning to become unmanageable for her, and she struggles to find comprehensive medical care in her region.
Sarah’s attentiveness to her appearance is one aspect of her masking, trying to hide her disease. Attending the recovery group is another. As Sarah’s mother struggles to make ends meet and to pay for Sarah’s medical care, Sarah hopes to ease her mother’s mind by making her believe that she is on the road to recovery. However, Sarah continues to use heroin, claiming it helps stave off the effects of her disease. Sarah’s boyfriend is frustrated by Sarah’s lack of interest in sex, not understanding that she is feeling the effects of her disease. Recently, an argument between them escalated, and Sarah hit her boyfriend before leaving. On her way out, Sarah stole her boyfriend’s stash of heroin. When she got home, she frantically tried to call him, but he did not answer. Feeling hopeless and trapped, she took five times the amount of heroin than she typically injects: “I started feeling like there was no way out, like I was living this big lie” (162).
Garcia returns to Lisa and Michelle’s story from the previous chapter. After Michelle died, Lisa stayed off heroin. However, when Garcia shows up at Lisa’s trailer later, she finds Lisa high. Garcia notes that she feels angry with Lisa for getting high after losing her daughter to the same drug. Lisa tells Garcia that when Michelle died, she had a copy of the Lord’s Prayer in her pocket, written in her handwriting. Lisa wonders what Michelle was trying to tell her with the prayer.
Chapter 4 Analysis
The three scenes that Garcia uses to open the chapter flesh out important ideas about how suicide and overdose are considered in different contexts. For the drug user, overdose is an escape, a way out. A nurse tells the researcher that patients often do not use the term “suicide,” but they describe a desire to die. She explains that how a patient reacts when they are revived speaks volumes about intent: “Believe me, it makes a difference whether they are happy or not” (168). Garcia asserts that suicide is a form of life, meaning it is another aspect of The Connection Between Land, Loss, and Experience. Garcia repeatedly reminds the reader that drug addiction cannot be understood singularly; instead, it takes a comprehensive understanding of how all aspects of life intermingle. These different accounts of overdoses as well as the different experiences chronicled in this chapter are meant to highlight the nuances in individual experiences rather than relying on stigmatizing ideas about drug use and suicide.
This all-inclusive approach is an important part of ethnographic and phenomenological research. Garcia immerses herself in the lives and experiences of the individuals she studies. She sets aside her own biases to consider how various factors intersect, aiming for objectivity. One way she achieves this is by acknowledging her biases when they arise, like when she is frustrated by Lisa’s relapse after her daughter’s overdose and her changing stories.
Sarah’s story highlights the complexity of personal experience, considering chronic illness as another motivation for using heroin. Her disease and its treatment mirror and influence her drug use—she takes both prescribed medications and heroin intravenously, blurring the line between drugs and medicine, and heroin helps her cope with both her emotions and the physical effects of her treatment and illness. Her need to care for others causes her to hide aspects of herself from her mother and boyfriend; she does not want her mother to worry about her drug use, and she feels guilty that her mother is working so hard to support her disease treatment. Sarah minimizes her own needs while internalizing an identity of shame: “Somehow, Sarah felt that these misfortunes were all her fault. She suspected that if she just left things would improve” (158). This language mimics other interviewees’ musings about escape—while Sarah is ashamed of her drug use, it also provides a temporary reprieve from her complicated feelings.
Another aspect of this complicated web of identity is how Sarah is treated by the other women in her recovery group. They judge her, even suggesting that she only attends group meetings to find male customers for sex work. Because they do not know of her condition, they make jokes about the way she walks. In an institutional space designed to usher in belonging and community, Sarah finds the recovery group to be one more place where she is made to feel like an outsider.
Sarah’s sense of self is influenced by The Institutional Shaping of Identity. The economic deprivation of her region leaves her without the care she needs for her disease. Doctors tell her she would be better off moving to another state, a decision that requires both money and a willingness to leave behind loved ones. The low quality of her care causes Sarah to seek respite outside of prescription medication.
While talking with the hospital nurse, Garcia is struck by the language the nurse uses, speaking about overdose and suicide as though they are inevitable, natural conclusions to drug addiction. However, she later learns that this callousness is born out of frustration with the institutional approach to addiction treatment. The nurse opens a new way of thinking about institutional treatment: Overdose is the inevitable conclusion to addiction, while recovery is an accidental outcome.
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