Ethnography Review: Righteous Dopefiend

 The social crisis of homelessness has prevailed throughout the history of the U.S.  With the rapid spike in the homeless population in the 1980s, the current estimates on the number of homeless people reaches highs of up to 2 to 3 million individuals (Link et. al 1994). As seen in Philippe Bourgois and Jeff Schonberg’s photo-ethnography, “Righteous Dopefiend,” the hardships that surround the daily lives of those living on the streets extend further than the lack of having a roof over their heads. These two anthropologists explore the tribulations that come with life on the streets combined with the physical dependence of heroin as they insert themselves into a homeless community in San Francisco. Through the unbiased, documentary-style of research on this homeless community, it is clear that addiction and homelessness has important social and medical implications. As this ethnography reveals through firsthand accounts of a community of disadvantaged addicts, the structure of society often produces and reproduces this disadvantage.

For over 10 years Bourgois and Schonberg follow the daily lives of a group of people referred to as the Edgewater homeless. These individuals come from different ethnic backgrounds and have different histories. However, disregarding their apparent differences, these individuals have built the Edgewater community based on one thing - the shared culture of homelessness and drug addiction. According to Havilland, members of a particular community share culture. The shared culture allows certain behaviors to be acceptable within the community. Every decision and action made by the Edgewater community is made with one goal in mind and that is “where am I going to get my next fix?” (Bourgois and Schonberg 2009:8). Whether it is alcohol, crack, or heroin, substance abuse has disrupted the natural progression of life for every person living in Edgewater. This ethnography has captured the panhandling, stealing, hospitalization, tears, joys, and struggles of life on the streets. In a conventional community, these actions are not socially acceptable however this is standard within the culture of addiction.

Bourgois and Schonberg aim to shed light on the situation of the characters they followed with an insider perspective rather than the usual outsider perspective. Often times, society tends to label the unknown and the strange as the “other.” To break this convention, Bourgois and Schonberg give opportunities to voices normally unheard. It tells the story of Tina, an African American woman living among the Edgewater community, with accounts of her early childhood exposure to sex and drugs to the direct observation of her addiction into heroin into her detox program and back to relapse. As another member, Sonny, states, “if we knew why we were out here, then something could be done. None of us going to say, ‘I want to be a dopefiend all my life.” This contrasts the popular notion of the dirty and lazy addict whose individual choice has caused them to be a nuisance to society. Ultimately, by hearing the voice of this small community, many other Tina’s and Sonny’s are also being heard.

Heroin addiction has great health and medical implications. The term addiction does not have an entry in the American Psychiatric Association’s diagnostic manual (5). Often, psychological diseases are questioned as true diseases due to the lack of clinical observations of the illness. For example, those with psychosis find that their difficulties dealing with their illness are significantly magnified because their experiences with the illness are inexpressible (Corin et al 2007). Heroin addiction is an exception to this. Frequently, heroin addiction becomes full blown physiological dependence to the drug in which its symptoms are clinically measurable. Many users complain about being “dopesick.” Within hours of being off the drug, withdrawal symptoms creep up. Bones ache, noses drip, eyes burn, skin itches and as Carter explains it withdrawal causes vomiting, uncontrollable bowel movements, and worst of all, anxiety (81).

In addition to physiological dependence, drug use and homelessness involve other medical aspects. The Edgewater homeless face chronic hunger, high exposure to infectious diseases, abscesses due to injection, colds, flus and violence (5). In extreme cases, these medical outcomes result in hospitalization. Further more, disease through the direct use of heroin injection like hepatitis C or HIV/AIDS is a possible and terrifying fate. The outbreak of HIV in the 1980s is directly related to injection drug use (106). This timely outbreak runs parallel to the rise in the homeless population in the 1980s for the U.S. Wherever homelessness occurs, these health is an issue that requires public attention.

           

When the health needs of any group of people are at risk it becomes a public health issue. Due to the relationship between injection drug use and HIV, the problems faced by many like the Edgewater community can be viewed as a public health issue, more so than a global health issue. Although HIV/AIDS is an issue in developing nations like Africa it is due to sexual transmission. The HIV/AIDS dilemma in the U.S. is caused and dealt with in a different approach. The most effective public action for reducing infection in the case of injection drug use, as the ethnography discusses, is harm reduction. Harm reduction infuses medical technicalities with social justice. Harm reduction rather prevention is a more realistic intervention due to heroin’s physiological effects. Reduction couples education with safer injection methods. Those of the Edgewater community are taught never to share injection needles and other paraphernalia. However, education becomes hardly applicable when living on the streets. “Their top priority was to avoid dopesickness, and that required them to share publicly and frequently in order to build a generous reputation,” (107). Therefore, although reduction is more effective than absolute prevention of heroin use, goals are realized as more idealistic when applying it to street life.

Harm reduction is a progressive approach to public health outreach because it produces nonjudgmental aid and provides an alternative to institutional barriers and hopes to reduce stigma in medical services (106). Through the study of the lives the Edgewater homeless, Bourgois and Schonberg brought to light the stigmatization that is deeply embedded in U.S. social structure one being hospitals and medical service. Stigma has the capability of fostering types of medical attention and intervention because medical knowledge is shaped by the framing and representation of social groups.

 “Overwhelmed by an onslaught of complicated and vulnerable people like Hogan [an Edgewater homeless], many of the frontline emergency room personnel became harsh taskmasters. A national-level institutional problem caused by federal cutbacks for indigent care reimbursement, initiated in the 1980s and exacerbated in the late 1990s, expressed itself in interpersonal confrontations and insults at the hospital gates, where desperately sick people with no health insurance clamored, often unsuccessfully, for care” (98).

 The negative perceptions of the homeless population and also the stigma surrounding drug use gave reasons for nurses to reject care, for hospitals to reject admittance and for doctors to operate without anesthesia, denying painkillers to “punish” addicts. On the opposite end, many homeless refuse to seek medical attention until absolutely necessary due to the stigma and fear of rejection.

With that said, society is structured in a way that disallows the homeless population to climb out of their current social state. The War on Drugs in the U.S. criminalized those who needed to be medicalized. Often these people were thrown into jail for not only heroin and the possession of paraphernalia, but also for urination, sleeping outside, and public intoxication (113). In jail, many are reduced to great agony due to withdrawal symptoms and no medical attention to them. During times where detox or heroin treatment programs were sought out, patients, especially homeless patients relapsed at high rates. Relapse is due to weak follow-up care after treatment. Many homeless do not have adequate housing to go home to or employment lined up or even the physical condition necessary to be employed. In addition, the social network and lack of support that runs in this culture of homelessness aids to relapse. For example, Narcotics Anonymous self-help meetings were the only form of free post-detox aid in the 1990s and 2000s, causing Tina to relapse after her detox program ended (281).

Ethnographers aim to convey messages across different worlds, classes and culture. Through “Righteous Dopefiend,” Bourgois and Schonberg were successful in doing what they aimed to do: detail the life of homelessness and addiction as it exists and show the relationship between institutional forces and their role in producing addicts. Bourgois and Schonberg’s stance on homelessness is strengthened through the writings of an ethnography rather than through empirical research because it gives a voice to those normally unheard and experiences that would not be captured otherwise. Through photos, they do not downplay the hardships of addiction however they do not subject these vulnerable people to scorn and judgment.

Insight on physiological withdrawals and harm reduction strategies informs readers of the controversy that comes with how public health should deal with heroin addiction. Facilities like the needle exchange are great ways to reduce the spread of disease through distribution of clean needles, free Hepatitis C testing and education. However, even up until the mid-2000s, federal funding and support from politicians were limited in any public health programs or research that included words such as needle exchange, harm reduction and condoms (302). This is due to the misconceptions of addiction and the lack of public insight to this unknown culture. “Righteous Dopefiend” strategically aims at public education through its readers in hopes of decreasing stigmatization and increasing awareness and care. As we walk down the streets, everyday there is a glimpse reminding us that homelessness exists however. Whether it is a person laying in a sleeping bag or begging you for extra change, this small glimpse of what we see is the realities for these people. It is every second, everyday, every hour, months, years, even lifetimes for some people and Bourgois and Schonberg has managed to capture the stories of homelessness through Edgewater’s community of addicted bodies. 

Ti Nguyen 

1. Bourgois, Philippe and Jeff Schonberg. 2009. Righteous Dopefiend. Berkley: University of California Press.

2. Corin, Ellen, Rangaswanu Tgaram and Ramachandran Padmavati. 2004. "Living Through a Staggering World: The Play of Signifier in Early Psychosis in South India."

3. Link, Bruce G., Ezra Susser, Ann Stueve, Joh Phelan, Robert E. Moore and Elmer Struening. 1994. “Lifetime and Five-Year Prevalence of Homelessness in the United States. American Journal of Public Health. 84(12): 1907.

4. Lecture discussions, ideas and themes