The Pastoral rehab: Drug addiction, therapeutic discourses and self-transformation
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Abstract My research project involves ethnographic work focused on the culture and social relationships of drug addicts and their responses to different treatment practices. I conducted six months of fieldwork in San Francisco, California, where I observed institutional practices at an inpatient residential program for drug addicts. Having experience from working at different drug rehabilitation centers in Norway, I have explored if different understandings of the state and of citizenship create different treatment practices and whether this affects the clinical construction of the drug addict and the addict's own responses to therapy. My emphasis is on the historical formation of new practices for governing drug addiction and drug addicts. Drug addicts, like prisoners, patients and the mentally ill, have to be studied with an awareness of a historical perspective. The use of drugs, tolerated or forbidden, cannot be studied without taking into account the socio-cultural context within which drug use occurs, and this includes a political context made up of complex power relations. These practices can be understood using Foucault's historical work on the emergence of new practices of governmentality in the West, which were new practices for forming subjects, dispositions and behavior with a view to how these could contribute to the social order and its productivity. Systems of power and knowledge have involved the development of a set of technologies to restructure the subjectivity of those marginalized and alienated in modern society, such as drug addicts in rehabilitation programs. My thesis studies the emergence of new juridico-political forms of regulations that characterize contemporary addict's lives, and explores their relation to the state, doctors and family. I have mainly focused on treatment philosophies and practices in relation to wider social structures, where Foucault's famous inquiry into pastoral powers has been used as a central concept in exploring how subjects are influenced by practices of power and knowledge. The medicalization of social life has resulted in a growth of therapeutic practices, and I have examined dominant therapeutic discourses in addiction treatment and their central concepts and models of selfhood derive from what has been termed a therapeutic culture" (Illouz 2008; Madsen 2011). The model of the addicted subject", involves a pastoral project that works upon the motives, desires and self-awareness of the addict who is nowadays defined as a client. There are certain constructions of the drug addict that gives rise to discourses and practices that emphasize self-control, self-discipline and self-awareness. There are certain semiotic processes that are involved in this process of turning people into clients, and I have examined culturally and clinically prescribed ways of speaking from the positions of clients as well as staff members. I have focused on the increasing influence of the therapeutic ethos" and how dominant scripts have been institutionalized in addiction treatment programs, and how clients and staff members make sense and use of the therapeutic language and its models of selfhood.