Rx 25 / Righteous Dopefiend
Jeff Schonberg, photograph from the series Righteous Dopefiend, 2009
Photograph provided by Jeff Schonberg
They survive in perpetual crisis. Their everyday physical and psychic pain should not be allowed to remain invisible.
- Philippe Bourgois and Jeff Schonberg, Righteous Dopefiend (2009)
This photograph is taken from the Slought exhibition, Righteous Dopefiend: Homelessness, Addiction, and Poverty in Urban America, a gripping photoethnography by photographer Jeff Schonberg and anthropologist Philippe Bourgois highlighting twelve years in a community of homeless heroin addicts and crack smokers. Haunting black-and- white photographs deftly interwoven with edited recorded conversations, detailed field notes, and critical theoretical analysis portray the lived experience of homelessness and addiction. Here, a bearded man with a syringe crouches next to an exit ramp in a highway embankment, presumably within the shooting gallery known as “the hole.” An oncoming car whizzes by to the right. Within this matrix of bustling Silicon Valley freeways—conduits that lead to some of the highest-paying jobs and most expensive real estate markets in the country—lies what Bourgois calls “a classic inner-city-no-man’s-land of invisible public space.” Those who inhabit this space are invariably trapped by the very infrastructures that facilitated economic growth and exacerbated the stark juxtaposition of wealth and poverty. Mounted at Slought in 2009, Righteous Dopefiend attested to the entwined crises of addiction, financial destitution, segregation, housing shortages, and over-policing and compelled viewers to interrogate the systemic and socioeconomic etiologies of addiction.
In a warehouse district known as Edgewater, on the edge of the city’s defunct shipyards, Bourgois and Schonberg employed participant-observation fieldwork among two dozen homeless heroin and crack users. In the decade of research that ensued, Bourgois and Schonberg sought to humanize the Edgewater homeless as a community upheld in part by gift-giving and networks of reciprocity. Abandoned by the formal economy, the community navigates a complex nexus of mutual obligations and boundaries, victimization, betrayal, violence, predation, abuse, generosity, camaraderie, hustling, and shifting power dynamics—all in order to survive. Righteous Dopefiend reveals the internal social logics and nuanced perspectives that homelessness and addiction impose on a practical level, as well as the unintended consequences of public policy, cultural, political and economic structures, all of which exacerbate the levels of suffering faced by the indigent across the United States.
Over the past century, the visual presentation of violence and poverty has provoked intense debate about the tendency to aestheticize suffering. Critics have argued that social documentary photography, in foregrounding empathy for those represented, often fails to provide adequate socio-political context for images. By failing to distinguish between perpetrators and victims, the broader social structural forces that constrain the lives of the poor are obscured. Righteous Dopefiend brings anthropology’s longstanding engagement with forms of human suffering to bear on challenges of representation, objectification, and analytical framing. In positioning the aesthetic component of their work within an anthropological framework, Righteous Dopefiend illuminates
a broader social understanding of the practical experience of addiction, and the daily struggle to survive in the face of pervasive structural violence.
reflections…
Bourgois and Schonberg contend that those who subsist “at the margins” are largely invisible to society, rendering their lives a “public secret.” How are we socialized to ignore or neglect structural violence and the suffering it imposes, despite its pervasiveness? And when it is seen, how is it then essentialized through a process of othering? Rather than casting Bourgois and Schonberg’s subjects as societal anomalies or outcasts of an otherwise prosperous society (i.e., Marx’s “lumpenproletariat”), how can we normalize their plight and recognize its ubiquity, regardless of class or culture? What do we share with those in “perpetual crisis”?
In November 2020, OxyContin manufacturer Purdue Pharma pleaded guilty to felony charges for its role in fueling the opioid epidemic. As The New York Times reported, at the advice of consulting firm McKinsey & Company, Purdue used “aggressive marketing tactics to convince doctors to unnecessarily prescribe opioids—frivolous prescriptions that experts say helped fuel a drug addiction crisis that has ravaged America for decades.” Further, prominent cultural institutions and biomedical research centers have historically received significant financial support from the Sackler family, owners of Purdue Pharma. The Metropolitan Museum of Art, Guggenheim Museum, and Whitney Museum, alongside many research universities including Yale’s Sackler Institute for Biological, Physical and Engineering Sciences, have indirectly relied on the profits of what we might call “the pain economy.”
How can we better understand the destitution of the subjects of Righteous Dopefiend as the byproduct of a capitalist, resource-laden society? How has over-prescription intentionally reduced people to their addictions and function to consume? How can arts and medical institutions contest the violence of the profit-driven pharmaceutical industry, even as they are oftentimes intertwined or complicit with its patronage?
What can physicians learn from Bourgois and Schonberg’s longitudinal relationship with their subjects, which unfolded over nearly twelve years? How might their durational engagement with the Edgewater homeless challenge and inspire physicians to leverage their unique clinical vantage to drive social change?
Now more than ever, medicine is increasingly challenged to broaden its biomedical gaze and concretely engage with the sociocultural and political-economic dimensions of disease. Structurally- imposed suffering is frequently unacknowledged in the clinical encounter, and as Seth Holmes, MD, Paul Farmer, MD, PhD, and others have argued,“when physicians use only biologic or individual behavioral interventions to treat dis- eases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve.” Bourgois and Schonberg go on to describe how the Edgewater homeless were generally not interested in “friendlier, culturally appropriate” treatment, preferring stable access to resources and quality care.
How does well-intentioned “friendliness” on the part of a practitioner, dispensed within an economically-driven and inaccessible system, prove wholly ineffective in the face of structural violence? Despite a genuine desire to serve homeless populations, deficiencies in medical education have rendered many trainees unaware of bureaucratic and structural barriers impeding access to and delivery of resources to those most vulnerable. How can medical education learn from fields such as photo-ethnography and public anthropology in teaching principles of social medicine?
sources
Bogdanich, Walt, and Michael Forsythe. “McKinsey Proposed Paying Pharmacy Companies Rebates for OxyContin Overdoses.” The New York Times, The New York Times, 27 Nov. 2020, www.nytimes.com/2020/11/27/business/mckinsey-purdue-oxycontin-opioids.html.
Bourgois, Philippe I., and Jeff Schonberg. Righteous Dopefiend. University of California Press, 2009.
Hoffman, Jan, and Katie Benner. “Purdue Pharma Pleads Guilty to Criminal Charges for Opioid Sales.” The New York Times, The New York Times, 21 Oct. 2020, www.nytimes.com/2020/10/21/health/purdue-opioids-criminal-charges.html.
Holmes SM, Hansen H, Jenks A, et al. Misdiagnosis, Mistreatment, and Harm - When Medical Care Ignores Social Forces. N Engl J Med. 2020;382(12):1083-1086. doi:10.1056/NEJMp1916269.
Karandinos, George, and Philippe Bourgois. The Structural Violence of Hyperincarceration - A 44-Year-Old Man with Back Pain: NEJM. New England Journal of Medicine, 17 Jan. 2019, www.nejm.org/doi/full/10.1056/NEJMp1811542.
Liscia, Valentina Di. “Museums Were Key to Sackler PR Strategy, Family Group Chats Reveal.” Hyperallergic, 23 Dec. 2020, hyperallergic.com/609919/museums-were-key-to-sackler-pr-strategy-family-group-chats-reveal/.
“Righteous Dopefiend”. EurekAlert!, 2 July 2009, www.eurekalert.org/pub_releases/2009-07/uop-rd070209.php.
“Righteous Dopefiend.” Penn Museum, www.penn.museum/about-collections/registrars-office/traveling-exhibitions/righteous-dopefiend.
Righteous Dopefiend. Slought, slought.org/resources/righteous_dopefiend.
