Social Science of the Syringe

A Sociology of Injecting Drug Use

Nicole Vitellone

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781317223863
• Edition: 1
• Topic: Medicine
• Subtopic: Sociology

This book addresses the history of harm reduction. It evaluates the consequences and constraints, stakes and costs of the policy of needle exchange for the purposes of harm prevention and health research. Vitellone situates the syringe at the centre of empirical research and theoretical analysis, challenging existing accounts of drug injecting which treat the syringe as a dead device that simply facilitates social action between humans. Instead, this book complicates the relationship between human and object – injecting drug user and syringe – to ask what happens if we see the object as an intra-active part of the sociality that constitutes injecting practices. And what kinds of methods are required to generate a social science of the syringe that is able to measure injecting sociality?

Social Science of the Syringe develops material methodologies and epistemologies of injecting drug use to enact the syringe as an object of intellectual inquiry. It draws on the methodologies of social anthropology, Actor-Network-Theory, Deleuze's empiricism and new feminist materialism to move towards materially-engaged knowledge production. This interdisciplinary approach improves understandings of the causes and effects of injecting behaviour and the problem of needle sharing, as well as providing a more robust empirical framework to evaluate the motivations and consequences of drug use and drug policy. This book will appeal to researchers and students interested in the sociology of health and illness, STS, Actor-Network Theory, empirical sociology, medical anthropology, social and cultural anthropology, addiction theory and harm reduction.

1
Politics

In his historicisation of Harm Reduction as a social policy of public action, Didier Fassin (2012) highlights the political effects of compassion in radically transforming the status of injecting drug users in the late 1990s from social deviants to social sufferers. Tracing the shift in public feeling towards injecting drug users from criminalised deviants to subjects of compassion, this chapter investigates the affective politics of drug suffering. My aim is to consider how and under what conditions compassion is elicited and whether such emotions institute critical or conservative social emotions and social policy. Focusing on the subjects and objects of Philippe Bourgois’ photo-ethnographic research on homeless injecting drug use in the US and Barnardo’s child poverty campaigns in the UK I evaluate images of drug suffering and the politics of compassion from a different angle. By evaluating the ways compassion positions publics in relations with injecting drug sufferers affectively, including shaping perceptions and understandings of the causes and effects of drug addiction, I demonstrate the significance of the syringe as a moving device in constituting a shift in public action. In so doing I show how public feelings of sympathy towards the injecting drug user has implications for the development of Harm Reduction policy and the historicisation of the syringe.

Philippe Bourgois’ critical photo-ethnography of drug suffering sets out to produce social knowledge of injecting drug use. In his much cited and award-winning ethnography In Search of Respect: Selling Crack in El Barrio (2003a) and Righteous Dopefiend (2009), Bourgois presents his audience with a socio-structural analysis of drug addiction. Combining image and text, Bourgois aims to show us how heroin injection in inner-city spaces concerns ‘extreme forms of structural violence’ (2003b, 32), with the highest proportion of addicts found amongst ‘the most exploited population groups suffering from the most intense forms of systematic racial discrimination and spatial segregation’ (2003b, 32). Through photography and testimony Bourgois’ goal is to bring us closer to the social suffering of the disenfranchised. A mixed method approach is critical, he argues, in ‘the face of paralysing, depoliticising postmodernist critiques’ (Schonberg and Bourgois 2002, 390) in the social sciences, particularly in anthropology, where ‘moralistic and depoliticized accounts of urban marginality’ (Bourgois 2002b, 229) prevail. The problem with deconstructive analyses, according to Bourgois, is the tendency to individualise, moralise and sanitise the social experience of institutional and interpersonal violence amongst the urban poor. Focusing on the social context of violence, Bourgois aims to avoid distinguishing between the worthy and unworthy poor and to expose the reality of drug suffering.

Drug suffering

What sets Bourgois’ ethnographic work apart is not just his commitment to ‘the documentation of human pain and social injustice’ but the production of a ‘clearer political critique of how power relations maintain inequality and (useless) social suffering under neo-liberalism’ (2002b, 229). By using photography as a research tool within ethnographic practice, Bourgois ‘draws emotion, aesthetics and documentation into social science analysis and theory and strives to link intellect with politics’ (Bourgois and Schonberg 2009, 15). Despite his methodological optimism Bourgois is worried about the implications of his photo-ethnography for his research subjects and the audience. ‘What are we imposing? What are we missing? What are the stakes of exposure to a wider audience?’ he asks (Bourgois and Schonberg 2009, 15). Whilst the method of photo-ethnography is considered to produce a clearer picture of the social context of suffering, Bourgois’ concerns around emotion, aesthetics and documentation draw attention to cultural representations of human pain and social injustice and their political effects. His reservations regarding public emotion raise questions about the consequence of drug suffering’s incorporation into cultural production and the politics of public feeling.

In order to better understand the ways public affect shapes the political imaginary, Arthur Kleinman and Joan Kleinman (1997) call for a critical evaluation of the changing context of public action and cultural representations of human suffering. The social experience of reading and watching suffering, they argue, involves not just shifts in social structures and social policies but powerful cultural processes that transform the sufferer’s social status as a victim. Rather than focus on observations of social suffering Kleinman and Kleinman (1997) highlight the benefits of an interdisciplinary engagement that brings together alternative perspectives on the social imagination of suffering. Postmodern critique, according to the Kleinmans, is not paralysing or depoliticising but can invigorate understandings of suffering and its centrality to politics. In order to produce better accounts of ‘how social experience is being transformed’, the goal they argue is to ‘reconstruct the object of inquiry’ (1997, 19). Taking up these concerns, I consider how an interdisciplinary approach to social suffering expands political understandings of how injecting drug use shapes and is shaped by the political imaginary.

The weight of the world

In her deconstructive analysis of compassion as ‘an emotion in operation’ (2004, 5, emphasis in original) Lauren Berlant suggests compassionate emotions enact the social in particular ways. For Berlant the operation of compassion describes a social relation between a sufferer and the compassionate one. In alleviating the pain of others – who are over there – the compassionate enact their social privilege (Berlant 2004, 4). This relationship is brought home and made intimate ‘by sensationalist media, where documentary realness about the pain of strangers is increasingly at the centre of both fictional and non-fictional events’ (Berlant 2004, 5). In addressing the social life of compassion, Berlant is concerned with the ‘dynamics of its optimism and exclusions’ (2004, 12). Her central focus is not the intensity of compassionate emotions but ‘how do we know what does and what should constitute sympathetic agency?’ (Berlant 2004, 5).

Despite her reservations regarding the compassionate turn, Berlant finds the emotional weight of Pierre Bourdieu’s (1999) ethnographic theoretical work in The Weight of the World: Social Suffering in Contemporary Society on both the research subjects and the reader confrontational and challenging. The greatest contribution of this sociological text, she argues, is its ability to contest feelings of compassion. The power of the testimony is that ‘it is hard to know how to respond’ (Berlant 2004, 8). Whilst Berlant considers the ‘subjective experience of inequality’ in Bourdieu’s sociological enterprise to be politically and affectively strategic, Angela McRobbie (2002) is less than convinced. The emphasis on extensive recordings and transcriptions of spoken voices, according to McRobbie, overstates the personal experience of suffering at the expense of a broader understanding of the social and cultural context. The ‘voice of pain’, she argues, ‘is not enough’ (McRobbie 2002, 131).

McRobbie’s criticisms of The Weight of the World regarding the focus on misery, as opposed to everyday life ‘and the things which co-exist with suffering and disadvantage’ (2002, 136), are directed not at the research participants but the sociologists themselves. The social researchers, she argues, are compromised by their own methodologies of intimacy and empathy. Their emotive tone asks the reader to respond with empathy, yet the lack of ‘“thick description” disallows a more engaged response’ (2002, 134). What we are left with, according to McRobbie, is a ‘stark atrophied place without hope’ (2002, 136). Although the researchers’ claim that intimacy with their research subjects produces a critical self-understanding of the informants’ structural position, and a subsequent shift in the habitus, McRobbie suggests such political interventions are overstated. ‘[O]n occasion the respondents appear to be exploited for their own grief’ (2002, 135).

If McRobbie’s main concern with Bourdieu’s The Weight of the World is its emphasis on personal suffering, at stake for Berlant is an affective politics of compassion. In not knowing how to respond to the interviewed subjects Berlant suggests the reader is denied both the pleasure of knowing about suffering from a comfortable distance and the privileged gift of compassion. Compassion ‘would seem beyond the point – or, more accurately, before the point, since no one in the text, the ethnographers or the interviewees, asks for compassion’ (Berlant 2004, 8). Instead we learn about ‘the kinds of dignity and indignity produced by the project of survival under the pressure of national and transnational capitalism’s inequities’ (Berlant 2004, 9). The demand not to respond with compassion to lives so overwhelmed by the present and without a certain future, according to Berlant, creates a political spectacle of suffering without compassion.

In withholding compassion, Berlant argues the social scientists in The Weight of the World neither liberate the research subjects from their experience of suffering nor convey a sense of helplessness. What we witness is ‘someone’s desire to not connect, sympathize, or recognize an obligation to the sufferer’ (2004, 9, my emphasis). These stories of survival demand of the reader – and the interviewers – ‘both analytic and affective presence’ (2004, 9). This presence, Berlant suggests, is politically effective in a context ‘where all the spectator wants to do is turn away quickly and harshly’ (2004, 10). Unable to do so, the reader moves beyond private compassion or sympathy and begins to forge a ‘personal relation to a politics of the practice of equality’ (2004, 9). What characterises this suffering, according to Berlant, is the extent to which ‘structural subordination is not a surprise to the subjects who experience it, and the pain of subordination is ordinary life’ (2000, 42). Feeling bad for others produces an understanding of the structural conditions of injustice. This pain, she argues, has the potential to create real structural social change.

The politics of injecting photography

Berlant’s assessment of the politics of affect in The Weight of the World adds a new critical dimension to Bourgois’ empirical concerns regarding the relationship between public emotion and public action. Combining the methods of participant observation with photography, Bourgois (2009, 11) aims to integrate ‘politics within aesthetics’ and close the gap between the representation and analysis of pain and social injustice. Whilst his method of collaborative photo-ethnography is new, the deployment of photography to capture the lives of marginal injecting drug users is not. As Fitzgerald (2002) explains, the photographic work of the artists Larry Clark and Nan Goldin in the 1970s created a particular genre of realist drug photography. What characterises this early body of artistic work as real and authentic, according to Fitzgerald (2002), is the artists’ participation as insiders within the frame. The audience encounters the artist’s desires, emotions and personal history as a work of art. In Clark’s series Tulsa (1971), Fitzgerald explains junkies shoot up together, often naked in trashed out rooms. Clark captures the cycle of violence, drug abuse and death through close-ups of himself, graphic images of the syringe, the practice of shooting up and the affect of the rush. The injecting scene in Clarke’s work, according to Fitzgerald (2002, 379) functions as a ‘form of narrative disclosure, it can categorise, individualise or isolate a character’. The syringe distances the drug user from normality. The object establishes the injecting drug user as other, as strange, and outside of the social, thus creating a distance between the injecting drug user and the audience.

Comparing these early images of injecting drug use with John Ranard’s documentary photographs of the Russian epidemic of HIV in the mid-1990s, Fitzgerald (2002, 371) points out that here there are ‘no graphic images of injecting that emphasize the size of the syringe or the spray of blood’. Instead of being confronted by an image of the injecting drug user as ‘primitive, perverse and suffering’, Fitzgerald (2002, 384) suggests Ranard’s photographs make visible a vulnerable social group at risk of HIV in their precarious everyday post-Soviet context. According to Fitzgerald, ‘we can learn a lot from these images’ (2002, 384). By making visible the social problem of drug suffering, ‘Ranard’s images feed into the global political economy of redemption’ (Fitzgerald 2002, 381). In ‘bring[ing] people closer to suffering’ and ‘connect[ing] our lives to the lives of others’ (Fitzgerald 2002, 384), Ranard’s images ‘link well to the redemptive need, to heal and make better the wounds of society’ and make ‘the individual, community and state amenable for intervention’ (Fitzgerald 2002, 381), particularly Harm Reduction.

Whilst the effect of Ranard’s injecting drug photography is considered by Fitzgerald and Bourgois to build public affect and public policy, Fitzgerald raises some questions regarding the social impact of such realist documentary on drug injectors themselves: ‘To what extent [does] a suffering image assist drug users?’ (2002, 384). ‘[W]ill it enable drug users to be anything other than wounded?’ (2002, 382). ‘Are we precluding the opportunity to tell a different story about drug users that may produce better long term political outcomes?’ (2002, 384). Fitzgerald’s concerns regarding the political effects of images of suffering call for closer attention to the ways photographs of the syringe move us. In what follows I examine the social impact of Bourgois’ injecting images of drug suffering. My goal is to assess the politics of empathy for injecting drug sufferers and the political effects and consequences of contemporary syringe photography on the sensory public. Focusing on photographs of homeless injecting drug use, I evaluate the object of the syringe as a moving device.

According to Schonberg and Bourgois, Ranard’s text ‘engages effectively an urgent public health debate and neglected human rights crisis’ (2002, 388). Ranard’s captions are ‘essential’, they argue (2002, 388), in demonstrating the destructive and dysfunctional effects of punitive public health policies. In combining human images of social suffering caused by police repression of Russian injectors with text, Ranard, according to Schonberg and Bourgois (2002, 388), ‘argues persuasively’ for the need to shift the focus from the criminalisation of drug users to Harm Reduction policies. Without the text they argue, ‘much of the meaning of the photographs would be lost or turned upside down’ (Schonberg and Bourgois 2002, 388). By visually engaging the debate on Harm Reduction, Ranard’s photographs ‘illuminate how government and public policy responses can shape the future course the epidemic takes’ (Ranard 2002, 356). The advantage of using informative photography to ‘draw us in’, according to Schonberg and Bourgois (2002, 388) is that it can give a voice to disenfranchised injecting drug users in such a way as to produce contemplation, deliberation and critical reflection by the viewer. ‘Strong photographs oblige viewers to ask questions about what is going on outside of the borders of the image – a suggestive lack of information can provide the impetus for critical thinking fuelled by personal interpretation’ (Schonberg and Bourgois 2002, 388, my emphasis). Critical social engagement involves ‘an emotional aesthetic – empathy, horror, awareness and anger’ (Schonberg and Bourgois 2002, 388).

Discussing the emotional effect of photography in generating social perception in the audience, Schonberg and Bourgois are sceptical that the camera alone can address and denounce social injustice. On one hand, they express a concern for the photographer’s standpoint as a ‘pornographic voyeur’: ‘the upper class spying on the lower class with their cameras. It is much easier to shoot down than it is to shoot up’ (Schonberg and Bourgois 2002, 389). On the other, they are concerned about the risk posed by photographs of marginalisation, suffering and destruction: ‘letting a picture speak a thousand words can result in a thousand lies’ (2002, 388). In order to minimise potential misreadings of extreme social suffering, Bourgois presents photographic images of injecting drug users alongside his ethnographic field notes:

I frequently selected and edited personal narrative so as to evoke sympathy from readers, so that they would recognize emotionally as well as intellectually their common humanity with the crack dealers, in spite of the many disturbing and potentially alienating details of mutual betrayal and intimate violence that I also documented. Rather than being under theorised, I believe that my quotes and conversations with the street level participants in East Harlem’s drug economy were edited, framed and introduced in a manner that, if anything, clobbers the reader on almost every page with political-economic arguments.

(Schonberg and Bourgois 2002, 227–228, my emphasis)

Whilst the text, personal narrative and captions are considered crucial for producing a critical social connection between the research subjects and the viewing public, the purpose of Bourgois’ photographs is to convey a closeness, familiarity and loyalty to his research subjects without compassion.

What sets Bourgois’ ‘ethically inspired images’ of drug photography apart from others, according to Fitzgerald, is the facelessness of the images (2002, 381). In de-emphasising the syringe and the drug user’s face, which is either absent from the frame, shadowy or obscured by cropping and silhouette, Bourgois avoids an emotional distancing between the audience and the drug injector and connects the public to the human experience of drug suffering. In so doing, Bourgois reconstructs the syringe as an object of sociological inquiry.

Take, for instance, his photo-ethnography of an injecting scene. The photo records the injection of a homeless middle-aged man by another in the neck. One is white, the other African American. We see the side profile of Jesse’s face and neck and the hand of Hank clutching the syringe. Reflecting on his field notes, Bourgois ex...

Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• Contents
• Acknowledgements
• Introduction: the history of harm reduction
• 1 Politics
• 2 Methods
• 3 Theory
• 4 Policy
• 5 Context
• 6 Practice
• Conclusion: beyond harm reductionism
• References
• Index