Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety

Copyrighted Material

I N T R O D U C T I O N

ConsideringthePoliticsofTherapeuticLanguage

Imagine you are an exile in a foreign land and have been diagnosed withwhatthenativesconsidertobeanincurableiftreatablediseaseThisdiseaseischaracterizedbytheinabilitytouselanguagetoexpresswhatyouthinkandhowyoufeelYouarenowbeingtreatedbylocalspecialists who work to rehabilitate your relationship to languageThroughacomplexsetoftraditionalceremonialpracticesthespecialiststeachyouhowtousewordsphrasesandeventuallyentireplottednar-ratives thatreferenceandrevealyour innerstatesThisrigorouspeda-gogical program which you have been told is therapeutic is also thespecialistsrsquomeansofevaluatingyouSoasyouengageinritualsofspeak-ingthespecialistsjudgetheextenttowhichyourutterancesmatchyourinnerstatesormdashinnativetermsmdashhowldquohonestopenandwillingrdquoyouareasaspeakerandasapersonHonestyopennessandwillingnessareofthehighestculturalvaluetheyaretheindigenousmarkersofindivid-ualintegritymoralityandhealthThisistrueaccordingtoboththespe-cialistsandthebroadersocietythathasordainedthemassuchAndasindicatedbyyourritualtreatmentthesevaluesarethoughttomanifestinandthroughthelocaltongue

Imagine too thatasidefromyourdiagnosedtroubles thesociety inwhichyounow livehasdeprivedyouofmanyof the thingsnormallyprovidedtoadultpersonsahomeorshelterthemeanstoclothefeedandcareforyourselfawaytotravelfromplacetoplaceameaningfulvocationandevenakinnetworkonwhichyoucanrelyNowsupposethatthespecialistsareempoweredtohelpyouaccessthesethingsbutcanalsokeepthemoutofyourreachSincethespecialistsrsquoevaluativepowersarelinkedwiththecapacitytodistributebasicgoodsandresourcesyourritual performancemdashthat is the way you speak in the course of yourtreatmentmdashhasfar-reachingmaterialandsymbolicconsequencesForin-stanceifyouhavechildrentheymaybetakenawaytobecaredforbyothersOrifyouhavebeensleepingunderbroadleaftreesorinstrangemenrsquoshousesyoumaybegrantedahomeofyourownwithawell-maderoofandalockonthedoor

AsaninitiateoftheseloadedritesofpassageperhapsyouhavecometobelievemdashlikethenativesmdashintherealityofyourldquodiseaserdquoInthiscase


2 bull Introduction

youalsodependonthespecialiststodeterminehowmuchmoreyouwillsufferwhichtheywilldiscernasyoutrytospeakinthewaystheyhavetaughtyouForasritualformulasthemantrasyouhavelearnedfromthespecialistscantransformaswellascondemnyouintheeyesofthelocalsItalldependsonhowyouusetheseefficaciouswaysofspeakingwhich the specialists will evaluate and oversee but can never totallycontrolIndeedhowwilltheyeverreallyknowifyouhavetrulyldquogonenativerdquo and been transformed by their treatment And what are thestakesnottomentionthepossibilitiesofdoingso

WelcometotheworldofmainstreamAmericanaddictiontreatmentwherediseaseisconceivedassomanyillegiblesignsthatcanonlybereadbythesober

Treating Talk and Talking Treatment

This book is based on more than three years of following an inter-connected group of professional practitioners1 and drug-using clientsthroughanetworkofsocialserviceagencies inaMidwesterncitythatwas(andstillis)sufferingtheeffectsofeconomicdownturndisinvest-mentandwelfarestateretrenchmentTheethnographyfocusesonldquoFreshBeginningsrdquomdashanoutpatientdrugtreatmentprogramatthecenterofthissocial servicenetworkmdashandtheassociationsandnegotiationsbetweentherapists and clients there As suggested above these everyday inter-actionsweresemioticentanglementsclientsworkedtoeffectivelyrepre-sentthemselvesandtheirproblemsandtherapistsworkedtoscriptorset the terms of these representations Because of the institutionalizedtiesbetweenFreshBeginningstherapistsandothersocialserviceprofes-sionalsavarietyofresourcesmdashfromtemporaryhousingtransportationvouchersandjobtrainingtomedicalcarelegalprotectionandthera-peuticacknowledgmentmdashhung in thebalanceof these intensiveverbaltransactions

ScriptingisanespeciallyimportantifpoorlyunderstoodelementofAmericansocialworkamultidisciplinaryfield inwhichpeoplersquos sym-bolic interactions have far-reaching material consequences2 While thecoerciveandcontrollingnatureofsocialworkandwelfarepracticeshasbeenwelldocumentedScripting AddictionillustratesthatsocialserviceprofessionalstalkaboutpeopleandproblemsinwaysthatresonatewithbroaderculturalnarrativesandtherebyappealtopowerfulinstitutionalaudienceswhocanhelpthemtohelpothersAfteralladdictioncounsel-orscaseworkersandsheltermanagersmdashliketheonesportrayedinthisbookmdashdonotsimplyevaluateclientsrsquowordsassignsofpersonalprog-


Introduction bull 3

ress(orlackthereof)theyalsousethoseevaluationsasthebasisforex-oneratingordamningreportstoparoleofficerscallstochildprotectiveserviceworkerswhocantakechildrenintostatecustodyorreturnthemtotheirhomesorconsultationswithwelfareworkerswhomayprovideorwithholdthemeanstoconsistentlyfeedclotheandhouseafamily

Thereforeclients indrugtreatmentunderstandablytrytoanticipateandcontrolhowtheirwordswillbe takenupbytheircounselorsandcasemanagersManynodoubtdothisbyinvestingpreciselyintheritu-alsofspeakingthatcomprisetheirtreatmentwhetherduringshelterin-takesclinicalassessmentsorindividualandgrouptherapysessionsYetatFreshBeginningsotherclientsworkedtomanagetheir institutionalfatebypracticingwhattheycalledldquoflippingthescriptrdquomdashthatisformallyreplicatingprescribedwaysofspeakingaboutthemselvesandtheirprob-lemswithoutinvestinginthecontentofthosescriptsForinstanceinaTuesdaymorningtherapygroupNikkiatwenty-nine-yearoldprogramveterancompellinglyrecitedaconfessional taleof triumphovercrackcocaine weaving autobiographical threads through the well-rehearsedplotofdenialdownwardspiralrockbottomandwillfulrecoveryJusthours later Nikki poured her nephewrsquos urine into a drug-screen vialmarkedwithherowninitialsThisethnographytraces themeaningofandcontinuityinsuchseeminglydisparateacts

Ifsocialserviceprofessionalsrelyonclienttalkinmeetingtheirdualchargetoevaluatepeopleanddistributeresourcesandifclientsleveragematerialandsymbolicresourceswiththeirwordsitisbecausetheirworkis in essence semioticwork Inotherwordsboth clients andprofes-sionalpractitionersuselanguagetoachieveavarietyofendsincludingthe production of personhood endowed with the qualities valued bylargerAmericansocietyInfactthemissionofFreshBeginningsmdashasin-scribed in itsveryownmissionstatementmdashwas toendowpeoplewithldquolastingsobrietyandself-sufficiencyrdquoAndwhileboththesegoalsobvi-ouslyentailedmanagingmaterialgoodsandresourcesthisbookshowshowandexplainswhysobrietyandself-sufficiencyaresocloselyassoci-atedwithaspecificwayofspeakingIndeedatFreshBeginningstherapywasfocusedonreconfiguringclientsrsquorelationshipwithlanguageratherthansimplyorevenprimarilyreconfiguringtheirrelationshiptodrugs

ThetalkingcurehasalonghistoryintheUnitedStateswherethepre-supposingdenotativefunctionsoflanguagearesystematicallyprivilegedbyspeakers(Duranti1988Irvine1989Rosaldo1982Silverstein19791996 2001 2003a Woolard 1998) that is the linguistic regularitiescharacteristic ofwhatBenjaminWhorf calledldquoStandardAverageEuro-peanrdquoaremaintainedbyusersrsquofolktheorieswhichpositthatwordspri-marilyfunctiontonamewhatrsquosldquooutthererdquointheworld(seeSilverstein


4 bull Introduction

1996)Asanumberofclinicalethnographieshavesuggestedtheprivi-legingofthepresupposingfunctionsoflanguageisparticularlyprevalentincontemporaryclinicalsettingsandsituationswherepeoplearesup-posed to reference and release inner denotata when they speak (egCappsandOchs1995Desjarlais19961997Wilce19982003seealsoCrapanzano1992)MoregenerallyAmericans tend toevaluateaper-sonrsquosintegrityandhealthbydeterminingifhisorherwordscorrespondwithwhatheorshealreadyldquotrulyrdquothinksorfeels3

As an ethnography of the United States Scripting Addiction showshowtreatmentprogramslikeFreshBeginningsarecentralsiteswhereculturalideologiesoflanguagearedistilledmdashthatisreproducedinpureand potent form Specifically this book focuses on the distillation ofwhatIcalltheideology of inner referenceanideologythatpresumesthat(1)ldquohealthyrdquolanguagereferstopreexistingphenomenaand(2)thephe-nomenatowhichitrefersareinternaltospeakers4Throughtheethnog-raphyofclinicalassessmentscaseconferencesandgrouptherapyses-sionsthepagesthatfollowshowthatboththedepthofclinicalpathologyandprogressinrecoveryarelinguisticallymeasuredasdrugusersrsquorepre-sentationsofthemselvesandtheirtroublesareheldagainsttheculturaland clinical ideal of perfectly transparent and exhaustivemdashor sobermdashinnerreferenceForaswewillseeFreshBeginningtherapistsdeterminedthe sobrietyof their clients by evaluating the sobrietyof their speechnamelyhowperfectlytheymatchedspokensignstoldquoinnerstatesrdquowith-outexaggerationflourishorfancy(cfKeane20022007)5

The ideologyof inner reference is particularlypotent in thefieldofmainstream American drug treatment which has long theorized andtreatedaddictionasasemioticmalady6In linewithawell-establishedstreamofclinicaltheorycrystallizedintheideaofaddicteddenialFreshBeginnings therapists averred that addicts suffer from the inability toread their inner states and render them inwordsAccordingly duringgroup and individual therapy therapists provided detailed guidelinesabouttheformalcomponentsofldquohealthyrdquoreferentialtalkandcarefullymonitored their clientsrsquo linguisticpracticesWords thatdid things likepersuade pronounce or protestmdashwhat J L Austin (1962) famouslycalled ldquoperformativesrdquomdashwere eschewed by program therapists whourgedtheirclientstoconfinetheiruseoflanguagetosimpleandsoberdenotation7ThusScripting AddictionshowsthatthefamiliarpreludeldquoHimynameisXandIamanaddictrdquoandthestructuredtalethatfol-lowsarenotthenaturaloutpouringsoftheaddictedcharacterinrecov-erynoraretheytheinevitablemanifestationofaculturalcompulsiontoconfessInsteadthesenarrativesarethehard-wonproductsofaclinicaldisciplinethatdemandsatotallyunmediatedlanguageonethatappears


Introduction bull 5

to transparently refer to and reveal the inner thoughts feelings andmemoriesofitsspeakers

Onemight simply argue thatmainstreamAmerican addiction treat-mentproducesldquoaddictsrdquobyurgingpeopletonameandtalkaboutthem-selves as such Scripting Addiction instead explains why professionalpractitionersdevotethemselvestoproducinga way of speakingwhichpresumablyallowsaccesstotheinnerstatesofspeakersincludingstatesofaddictionProceedingfromthepremisethataddictionisaculturallymediatedafflictionmdashmeaning thatboth the constitutionandclassifica-tionofanyrelationshipbetweenselfandsubstanceisinherentlycontext-specificmdashthisbookmakesthebroadargumentthatwecannotfullyun-derstandtheprojectofperson-makinguntilweunderstandthepoliticsoflanguage

Byethnographicallydemonstratingtheideathathowonespeaksinaclinical setting isboth thoroughlyculturaland inherentlypolitical thebookbuildsupon the rich anthropologicalworkon semiotic ideology(egBaumanandBriggs2003Brenneis1984Briggs1998Gal19921998GalandIrvine1995Hanks1996aHill19852000IrvineandGal2000Keane20022007Kroskrity19982000Mertz1998Philips1998Silverstein1979198519962004Woolard1998WoolardandSchieffelin1994)Whereasotherstudieshaveaddressedtheroleoflan-guageandnarrativeinsocializingpeopletobothtreatmentmilieusandldquohealthyrdquoidentities(egBezdekandSpicer2006Borden1992Bruner1990Cain1991CappsandOchs1995Ferrara1994Laird1994Man-cini 2007 Ochs and Capps 2002 Riessman 1990 1992 2003 Swora2001 White and Epston 1990 Wahlstrom 2006 Wilce 1998 20032008Wilcox1998)thisbookisdistinctiveinitsconcertedcriticalat-tentiontothepoliticalaswellastheculturaldimensionsoftherapeutictalkIndeedthechaptersthatfollowinvestigatetheculturalnegotiationsandcontestationsatplaywithinframesthatareoftenunderstoodtobesimplytherapeutic Scripting Addictiondemonstratesthattheritualsofspeakingthatchar-acterizemainstreamAmericanaddictiontreatmentarepoliticalinthreeprimarysensesFirstbyprescribingtalkthatcanonlyreferencetheinnerstatesof speakersaddictioncounselorseffectively ifnot intentionallyenervate clientsrsquo institutional critiques and discourage social commen-tarySecondtheritualsofspeakingthatproducethishighlypersonalizedtalknotonlyaffecthowsocialserviceprofessionalsevaluatepeopleandproblemsbutalsoimpacthowbasicgoodsandservicesaredistributedThirdScripting Addictiondocumentstheskillfulandsometimessurpris-ingwaysthatclientsmanagetoleveragematerialandsymbolicresourceswiththeirwordsAfterallscriptflipperslikeNikkieffectivelysuggest


6 bull Introduction

thateveryscripthoweverprescribedorhoweverprescriptiveisopentothepurposefulengagementsofskilledspeakersandactors

Text and Territory

Itislateautumnof1997Sixofusarespreadacrossthefrontporchofoneofthemanythree-bedroomframehousesthatlineCliffStreetFallenleavescrunchunderfootofpassersbywhodeterminedlyignoreourmea-suringeyesNonethelesstheirquickenedstridessuggestthatourcollec-tivestareshrinksthegapofthepostage-stamplawnandmakestheshortwalkpasttheporchfeelverylongindeed

Overtimetheneighborshavecometobelievethatthewomentalkingsmokingandstaringonthisporcharetheresidentsofaldquohalfwayhouseorhome or something like thatrdquoA fewhavewatchedmore carefullythroughcurtainedlivingroomwindowswitnessingwomenandchildrenpilingintothetwowhitevansthatarrivetowardtheendofeveryweek-dayAndthosewholivenextdoorknowthatonweekendsthepurplishgrayhouseisunusuallydarkandquietEventheswingsoutbackmdashwhichgeneratetinyshoutsofgleethroughouttheweekmdashsaginabandonment

Thewomenon theporchhave theirown theories about thepeoplewhopassbyandwhytheysostudiouslyavoidinteractionSometimeswhenthestaffandkidsareoutofearshotandthebanterontheporchhaslulledMarionplayfullyhecklesanattractiveblondneighborhoodmanwhomshecallsldquoPlaidrdquoOrNikkiboundsoffherstooptoaskastartled young woman walking by for a light (When refused NikkilaughsandcallsoutldquoIknowyougot oneIseenyousmokebeforerdquo)Mostofthewomenontheporchclearlydisapproveofthistypeofenter-tainmentscoldingldquoJustleavethepoorthingsalonerdquoOthersflipthroughhand-me-down magazines make lists of the weekrsquos errands and findotherwaystoignorethelatestanticsRegardlessthefunisoverbeforelongasthewomenextinguishtheircigarettesinanoldFolgerscanandfilebackupthenarrowdingystaircase toa second-storyroomwheretheirafternoontherapysessionsareheld

IfthepassersbydonrsquotknowwhattomakeofthehouseonCliffStreetanditstransientoccupantsitisnotjustbecausethismiddle-classresiden-tialneighborhoodisanunusuallocationforanoutpatientdrugtreatmentprogram8especiallyonedesignedspecificallyforhomelesswomenItisalsoundoubtedlybecausetheprogramisanexampleofarelativelynewformofsocialservicedeliveryIndeedtheFreshBeginningsprogramwasbornofa formalcollaborativeofpreviously independentcommunity-basedsocialserviceagenciesinacountyhithardbyde-industrialization


Introduction bull 7

andbesetbyawell-documentedlackofaffordablehousing9Bythelate1980s theseagencieswhichhad focused thebulkof their energiesonsuicidepreventionteenrunawaysanddrugoverdosesduringthe1970sfoundthatthemajorityofthosecallingtheirldquocrisishotlinesrdquowerefami-liesandindividualswithreportsrenderedinvoicestremblingwithcoldor fright that theyhadnoplace to sleep andnothing to eat Shiftingfocusaccordinglyeachagencyindependentlyscrambledtoprovideshel-terandsupportservicestotheswellingnumberoffamilieswithchildrennottomentionadultindividualswhometnewlyestablishedminimumfederalstandardsofhomelessness10mdashwhetherldquodoubled-uprdquoinfriendsrsquoorrelativesrsquohousesbecauseofanevictionaforeclosureoradomesticincidentormembersofthefarsmallergroupofldquochronicallyhomelessrdquointhecounty11

Inlightofthesejointlyrecognizedexigenciesfiveofthelocalagenciesserving thecountyrsquosone thousandnewlyhomeless familiesbanded to-gether to establish what would soon be called the ldquoHomeless FamilyConsortiumrdquo(HFC)From itsbeginnings in theearly1990sHFCac-knowledgedthatitsmemberswerearathermotleycrewcharacterizedbyradically different ideological proclivitiesmdashfrom the explicitly feministorientationofthedomesticviolencesheltertothemandatoryBibleStudygroupsheldatStThomasrsquosShelterThemostcriticalofthesedivisionsinvolved each agencyrsquos understanding of the etiology of homelessness

HUD

HFC

HELPNET WISH CARROLL ST SHELTER ST THOMAS SHELTER NEW NEST

Hope Health (Outpatient Services)

Fresh Beginnings

$$$

FigureI1FreshBeginningstheHomelessFamilyConsortium(HFC)andfundingpartneringagencies


8 bull Introduction

Whereas someagencies claimed that thewomen smokingon theCliffStreetporchhadbehaved theirway intohomelessnessbydoingdrugsandbearingchildrenoutofwedlockotheragenciesenteredtheconsor-tiumwiththeireyessquarelyfocusedonthepoliticaleconomiccorrelatesofhomelessnesswhichtheyarguedpropelledwomentobehaveastheyotherwisewouldnot12Notsurprisinglytheirinterventionsandinterac-tionswithclientsvariedaccordingly

RegardlessofhowtheydefinedthewidelyacknowledgedproblemofhomelessnessinthecountyandenvisionedappropriatesolutionsallHFCagenciesagreedthatcompetingforincreasinglyscarcefederalandstateresourceswasdisadvantageousbothtotheirrespectiveinstitutionalhealthandthewell-beingoftheirsharedclientpopulationBythemid-1990sprominent sources of federal funding were already clearly promotingldquowrap-aroundrdquo service delivery in which collaborating community-based service agencieswouldprovideuniqueandwell-defined servicesand thereby eliminate costly ldquoservice duplicationrdquo (Clark et al 1996Malysiak19971998)ldquoWrap-aroundrdquorhetoricwithitsoperatingframesofldquofamilyempowermentrdquoldquoindividualizedservicesrdquoandldquocommunityintegrationrdquoheldswaymoregenerallyinthedecidedlydevolvingpoliti-calclimateExpertlydeployingthelanguageofwrap-aroundintheirgrantapplicationtotheNationalOfficeofHousingandUrbanDevelopment(HUD) HFC was awarded a multimillion dollar grant to coordinatetransportationbetweenagenciesandsetupaninteragencycomputernet-worktotrackandmonitortheirsharedclientbaseMostsignificantlythegrantallowedHFCtocontractwithalargelocalCatholichospitalwith extensive psychiatric and substance abuse services called ldquoHopeHealthrdquoandestablishanintensiveoutpatientdrugtreatmentprogramthatwouldserveeligibleclientsfromanyofthecollaboratingagenciesIndeedifHFCagencieswereprimarilyboundbythecommongoalofgarneringshrinking federal funds theyalsosharedtheconvictionthatmanyoftheirclientswerebesetbydrugandalcoholproblemsthatwar-ranted the development of an outpatient drug treatment program de-signedspecificallyfortheirjointclientele

TwoandahalfyearsafterreceivingthefundingFreshBeginningswasstillHFCrsquosmostdistinguishedachievementdespitetheformidableprob-lemsthathadcharacterizedtheprogramrsquosdevelopmentanddailyadmin-istrationTherapistsandprogramadministrators touted theprogramrsquosspecialized servicesmdashincluding on-site child care and transportationmdashwhichothertreatmentprogramslackedTheyalsolaudedtheprogramrsquoscommitmenttoldquogender-sensitiverdquo13andldquoculturally-sensitiverdquo14serviceprovisionwhichtheyarguedwasessentialintreatinghomelesswomenFromtheprogramrsquosinceptionadministratorsassertedthatwhereastra-


Introduction bull 9

ditionaldrugtreatmentapproachedtheirclientsasgenericaddictswithhomogeneous needs their innovative program would recognize thathomelesswomenaddictshadspecialneedsthatcouldonlybeansweredwithcorrespondinglyspecializedservicesAndalthoughHFCprofession-alsdifferedinhowtheyconceptualizedexactlywhatwasspecialabouttheirclientsrsquoneedsandthereforehowtheyalignedthemselveswiththetreatmentprogramrsquosmissionofldquosobrietyandself-sufficiencyrdquotheyallfoundthatthetwintermsofldquochemicaldependencyrdquoandldquoeconomicde-pendencyrdquowereparticularlyefficaciousintheAmericanpoliticalclimateofthemid-1990shauntedasitwasbythattroublingfigureknownastheldquowelfaredependentrdquo

Identifying Icons and the Policies of Personhood

OpeningintheWhiteHouseRoseGardenwherePresidentBillClintonisldquoendingwelfareasweknowitrdquoandproceedingtoaday-longstaffre-treatonCliffStreetchapter1showshowHFCprofessionalsadoptedandadapteddiscoursesofdependencytopaintaportraitofldquotheclientrdquoonwhichtheirtreatmentprograminturncouldsymbolicallydependThechapterdoesnotsimplydrawaparallelbetweenneoliberalreform-ersrsquo casting of characters on national policy stages (such as ClintonrsquossupportingcastofldquowelfaremothersrdquowhojoinedhimintheRoseGar-den)andtheprogramdevelopmentstrategiesemployedbyFreshBegin-ningsprofessionalsMakinguseofdatagatheredattheretreataswellasprogrammeetingminutesandgrantapplicationschapter1alsoexam-inesthesemioticprocessesbywhichsuchpolitico-therapeuticdiscoursesareregisteredinpracticeandtherebyreproducedininstitutionalsettings(seeAgha19982007Mehan1996Matoesian2008Silverstein2003b20042006)15

Moregenerally chapter1highlights thepossibilitiesanddangersofcastingpoliticalandeconomicissuesofpovertyandhomelessnessases-sentiallytherapeuticconcernsInthissensethechapterfindsinspirationinNancyFraserandLindaGordonrsquos(1994)brilliantdemonstrationofhowthepoliticalandeconomicmeaningsofthetermldquodependencyrdquohavebeencollapsed intoanall-encompassingpsychological register so thatdependenceofthepooronthestatefora(lessthan)livingwageforin-stanceiseffectivelyrecastasthepathologicalmanifestationofinherentlydependentpsyches16WhileFraserandGordondiscussthehighlygen-deredtermsofldquowelfaredependencyrdquoandldquoco-dependencyrdquothestudyofFresh Beginnings allows us to consider how cultural ideas about eco-nomicdependencyandcontemporarydiscoursesofaddictionorldquochemi-caldependencyrdquoareentwinedIndeedScripting Addictionnotonlydem-


10 bull Introduction

onstratesthattherapeuticlanguageisinherentlypoliticalitalsohighlightshow contemporary American political language mobilizes a strikinglytherapeuticlexicon17

Taking Them In and Talking It Out

If passersbyonCliff Street recognized thewomenon theporch tobeldquohomelesswomenrdquoorldquodrugusersrdquomdashiftheyrecognizedthematallmdashtheprofessionalpractitionersaffiliatedwith theFreshBeginningsprogramgenerallyidentifiedtheirclientsasldquoconsumersrdquoinexpectationthattheywouldcometoinhabitthislabelandactaccordingly18Andregardlessoftheirindividualinclinationstowardtheprogramrsquosdualgoalsofimpart-ingldquosobrietyandself-sufficiencyrdquoFreshBeginningsclientssharedverypractical stakes in meeting professionalsrsquo expectations After all thevastmajority of incoming clients did not voluntarily attend the pro-gramInsomecasesclientshadbeenrequiredtoattenddrugtreatmenttomeetthetermsofparoleofficersorchildwelfareworkerswhowerein regular contactwithprogram therapists Inall casesFreshBegin-ningsclientsrsquosubsidizedhousingshelterandancillaryservicessuchaschild care tutoring and legal advocacy servicesmdashasprovidedby thefiveHFCagenciesmdashcontractually hingedon their therapeutic successonCliffStreet

IndeedtheFreshBeginningsprogramwasdesignedtoaddressdrug-usinghomelesswomenrsquosldquospecialneedsrdquothroughasystemofcoordinatedcareEach clientwas tomeet regularlywithherdesignatedHFCcasemanagerwhoseroleitwastoaddresspragmaticissuesrelatingtohous-ingemploymentoreducationaswellaswithaclinicalteamcomprisedoffamilycounselorsandchemicaldependency(orsimplyldquoCDrdquo)thera-pists And while the scheduling of regular case conferences betweentherapistsandcasemanagerswascommonlyplaguedbycaseoverloadandrampantstaffturnoverallprofessionalsworkedhardtocoordinatecare which also meant coordinating their evaluations of each clientrsquosprogress

ThusFreshBeginningsclients foundthat theywereheld to thedis-cerningtermsoftheirldquotreatmentcontractsrdquomdashwhichweredrawnupbychemicaldependencytherapistsLauraandSusanmdashfarbeyondthetreat-ment program And although it was immediately clear that therapistsevaluatedtheirtherapeuticprogressbasedonwhattheysaidintherapysessionsclientsalsosoondiscoveredthatmanyotherprofessionalprac-titionerscouldeventuallybepartytothewordstheyspokeonCliffStreetAccordinglychapter2notonlydocumentstheinstitutionalpathwaysbywhichclientsenteredintotheFreshBeginningsprogrambutitalsohigh-lightshowprofessionaltextsabouttheseclientsweregeneratedandtrav-


Introduction bull 11

eledwiththemaffectingtheflowofresourcesservicesandsanctionsThechapterbeginsbyfocusingontheveryfirstencountersbetweencli-entsandHFCcasemanagerswhichoccurredduringagencyintakeinter-views Describing professionalsrsquo work of procuring verbal evidence ofclientsrsquodruguseandtranslatingitintoinstitutionallylegibletextssuchascasenotesandprogramreferralschapter2thenfollowsacadreofHFC clients to the Fresh Beginnings program where they engaged inanotherroundofinterviewsknownasldquoclinicalassessmentsrdquo

Inadditionchapter2underscoresclientsrsquoeffortstocontrolhowpro-fessionaltalkandtextsaboutthemtraveledRatherthanseeingassess-ment reports and referrals as somuchbaggage this chapter takes theperspectiveofclientsandprofessionalswhounderstandthattheseinsti-tutionaltextscarrythepeoplerepresentedinthemasmuchastheotherwayaroundFinallyincarefullyexaminingprogramintakesandclinicalassessmentsaslinguisticinteractionschapter2alsoexplorestheepiste-mologiesoflanguagethatcommonlyunderlieinterviewingwhichhaveprofoundimplicationsforethnographicresearchaswellasclinicalprac-tice(seealsoBriggs19862007Carr2010)

Clinographies of Addiction

OnceadmittedtoFreshBeginningsonersquoseconomicaswellastherapeuticwell-beingwastiedtotheadoptionofaparticularwayofspeakingmdashafacthardlylostonthewomenwhoattendedtheprogramAsfiveofthesix women smoking on the porch that autumn afternoon reached thesecond-storytherapyroomtheyenteredintoaritualspacewhereldquosobri-etyrdquoandldquoself-sufficiencyrdquoweregeneratedmdashat least ideallymdashinwordsArmingthemselveswithmugsofinstantcoffeeandpastelcoloredtissueboxesclientssettled intodonatedcouchesarrangedaroundanemptyswivelingofficechairAsthetherapisttookthecentralseattheunpre-dictable cadence of multidirectional banter hushed sympathies aboutchildrenloversorjohnsandtheoccasionalexasperatedguffawseguedquicklyintothedailyregimenofgrouptherapyFreshBeginningsclientstook turns weaving the dayrsquos designated theme (eg shame codepen-dency responsibility) into personalized narratives of early trauma ac-celerateddenialrockbottomandwillfulrecoveryasanattentivethera-pistlookedon

ThewomenonCliffStreetdutifullyengagedintheseritualsofspeak-ingpreciselybecauseAmericanaddictionspecialistshavelongtheorizedaddictionasadiseaseofdenialmdashwhichafflicts theability to readandrenderinnerstatesinwordsmdashandaccordinglyprescribedthelanguageofinnerreference19Indeedwhetheroneentersaclinician-ledgroupther-apy session such as the one described above within the formal drug



treatmentsystemwhichconsistsofapproximately13600federalstateandlocalprogramsthatseeabout11millionclientsannually(N-SSAT2007)20or visitsoneof the approximately65000AlcoholicsAnony-mous(AA)orNarcoticsAnonymous(NA)groupsacrosstheUSonediscoversthatdrugrehabilitationcommonlyrevolvesaroundrehabilitat-ingthedruguserrsquosrelationshipwithlanguageFollowinglinearplotlinesthatproceed fromadenoteddirtypast toananticipatedclean futurerecoverynarrativesarethemeansbywhichmillionsofdrugusingAmer-icanshavepracticedself-insightintheireffortstogetsoberAndformanythousandsofpractitionersrecoverynarrativesarealsotheverymeasureofthisinsightandthereforethemosthighlyvaluedsignsoftheirprofes-sionalefficacy21

ThisisespeciallytrueofthosewhoespousetheldquodiseaseconceptrdquoofaddictionwhichhasbeenpopularizedthroughAAandinstitutionalizedbytheMinnesotaModelmdashacounselingapproachdevelopedinthe1940sand1950s(Cook2006)22Premisedontheideathataddictionisanin-curableiftreatablediseasethatspecificallyafflictsdrugusersrsquoinsighttheMinnesotaModelcombinespsycho-educationwhosegoalistobuildself-awarenesswithgroupcounselingwhichisdesignedtoconfrontde-nial(ChiauzziandLiljegren1993305)AtthetimethatHFCadministra-torswereenvisioningtheirtreatmentprogramandinscribingthatvisiononpapertoHUDmorethan90percentofprofessionaltreatmentpro-grams adhered to the basic principles and practices of the MinnesotaModel(Spicer1993seealsoMorgenstern2000WeisnerandGreenfield1995)AndeventhoughthoseinvolvedinthefoundingofFreshBegin-ningsinsistedthattheirprogramwouldbeuniqueinitsclinicalorienta-tionaswellasitsprogramdesignjustaglanceattheweeklyschedulebetrayedthenewprogramrsquosdebttotheMinnesotaModelwithaweeklypsycho-educational group individual counseling session and trip to alocalAAmeetinginterspersedinasolidslateofgrouptherapysessionsdevotedtotalk

AlthoughthediseaseconceptofaddictionhasbeenrecentlychallengedparticularlybyaninnovativenewapproachtoaddictiontreatmentcalledMotivationalInterviewingmanyofitsideasaboutdenialinsightandthelanguageofrecoveryarewidelysharedamongaddictionspecialistsand practitioners across otherwise distinctive theoretical orientations(eg Carroll 1980 Chafetz 1997 [1959] Davidson 1977b Doweiko1996 El Rasheed 2001 Fewell and Bissell 1978 Flores 1988 2004Hazelden1975Johnson1980Kauffman1994Kearney1996Kelleretal1995KrystalandRaskin1970Mandelletal2007Morgan2006OrsquoDwyer 2004 Peterson Nisenholz and Robinson 2003 Rinn et al2002Rosenfeld1994Rasmussen2000Razlogetal2007Speranzaetal 2004 Sifneos 1996 Spiegel and Fewell 2004 Taylor et al 1990



Tiebout1953Troisietal1998Wallace1978Walters1994Wurmser1974198519921995)Chapter3chartsthisrichterrainofclinicaltheory with an eye on how program therapists made use of well-establishedandwidelyheldideasaboutaddicteddenialinthecourseoftheir everyday practice For at Fresh Beginnings denialmdashalong withangerandshamemdashwastheorizedasakindofpsychicresiduethatsettledin layersatop the innermostregionof theselfpreventingasoberac-countingofitscontentsMakinguseofthedocumentstherapistsaccruedduring thecourseof theirprofessional trainingaswellas thepsycho-educational materials they distributed to clients and the explanationstheyofferedinethnographicinterviewschapter3examineshowLauraandSusanenvisionedthesubjectivityoftheirclientsTitledldquoClinogra-phiesofAddictionrdquo this chapternotonlydescribes the topographicalmodel of addicted subjectivity recognized in the Cliff Street therapyroomsitalsointroducesthelinguisticmethodstherapistsusedtoexca-vateit

AlthoughaddictionwastheorizedatFreshBeginningsasanincurablediseasechapter3workstoshedlightonthebroaderquestionsofjustwhyandinwhatsensesomanyAmericansinvestintheideathattalkingcuresAfterallthesobrietyofmindbodyandspiritarevaluedfarbe-yondthedomainofmainstreamAmericanaddictiontreatmentasistheideathatonecandemonstratethissobrietybyclearlyreadingandcleanlyrelaying inner states as thinkers from Augustine to Weber have sug-gested23Thus inethnographicallyexamininghowtheseenduringcul-tural values and ideasweredistilledonCliff Street chapter3 followsclientsfromthefrontporchandintothegrouptherapyroomwherether-apistsimpartwhatitmeanstospeaklikeandthereforebeahealthyandvaluableAmericanpersonaswellasarecoveringaddict

Addicted Indexes and Metalinguistic Fixes

ThursdayswereespeciallytryingdaysonthefrontporchofFreshBegin-ningsForonThursdaystheporchaccommodatedclientswhowaitedsometimesformorethananhourforthechronicallytardyprogramvantopickthemupandtransportthemtoalocalAAmeetingAsidefromthe wait many clients resented these required weekly trips especiallyafterthemanyhoursoftheweekthattheyhadalreadydevotedtotalkevenifintherelativelyintimatesettingofFreshBeginningsSomeliketheirtherapistLauraexpressedphilosophicalcritiquesofAApreferringitsldquosisterinstitutionrdquomdashWomenforSobriety(WFS)mdashanditsfoundationalmottoldquoWearetheauthorofthescriptbywhichweliveourlivesrdquooverAArsquosinjunctiontoldquoadmitwearepowerlessoveralcoholrdquoAndbecauseclients who had recently relapsed or otherwise broken program rules



were commonly required toattendninetyAAmeetings inninetydays(otherwiseknownasldquo9090srdquo)theregularThursdaymeetingfeltpar-ticularly punishing to some So in addition to waiting smoking andgrumblingontheporchclientssometimesdevisedcreativewaystododgeAAandthereforecircumventyetanotherroundoftalk

Thehybridizationof self-help and formalmodesof social service isclearlysymptomaticoflate-twentieth-century(post)welfarestatepolitics(Cruikshank 1999 Fairbanks 2009 Maskovsky 2001 Schull 2006)HoweverFreshBeginningsrsquointegrationofAArsquosdiseaseconcept(withitsemphasisondenial)WFSrsquosldquoThirteenAffirmationsrdquo(whichindicatethatrecoveringaddictscanclearlythinkandthereforebehaveinsoberways)andattemptedapplicationsofdialecticalbehaviortherapy24alsosuggestsignificantclinical hybridityaswellConsidertherapistsrsquoprolificuseofthetherapeuticsloganldquosecretskeepussickrdquowhichcombinesthepsycho-dynamicpresumptionthatinnerstatescanbedangerouslycysticunlesstheyareputintowordswiththecognitivebehavioralideathattheveryrecitationofsuchacatchysemanticpackagemayjustcompelthespeakertothinkandactaccordingly(StuartSmalleyrsquosmirrorincantationsmdashldquoIrsquom Good Enough Irsquom Smart Enough and Doggone It People Like Merdquomdash arecogentpop-culturalexemplarsofthepracticallyreinforcingifcon-ceptuallycontradictoryrelationshipbetweenthesemanticcontentandpragmatic forceof such therapeutic statements)And indeedwhen itcame toapplicationsof formalclinical theoryFreshBeginnings thera-pistsweregenerally inclined toheedldquowhateverworksrdquo inpracticemdashamottoindicativeofthepragmaticandeclecticorientationcommonamongmanyprofessionalpractitionersofpsychotherapy(Balletal2002Ford1996Taleff1997)25

AlthoughFreshBeginningswascharacterizedbyaclinicalheterodoxywherebyideasfromdifferentclinicaltraditionswerecreativelycombinedtomeetparticulardemandsofpractice therapistsrsquo theories about lan-guageanditsproperuseswereorthodoxandoftenexplicitlysoInthetherapyroomaroundthestafftableandinmanyconversationswithacuriousethnographertherapistsdelineatedtheingredientsofldquohealthyrdquotalk For example program therapists notonly remindedquiet clientsthatldquosecretskeepussickrdquotheyalsourgedcriticalclientstoldquoshareyourexperiencenotyouropinionrdquoandperiodicallyscrawledacrossthedryerase board ldquoD-E-N-I-A-L = Donrsquot Even Notice I Am Lyingrdquo for allclientstoseeFurthermoreontheeastwallofthetherapyroomthera-pistspostedcomplexrulesofspeakingwhichexplicitlyforbadeinterrup-tionrepetitionorgivingadvicerequiredeyecontactbetweenspeakersand listenersanddemandedthatemotionsbeldquoownedrdquoby thosewhoexpressedthemThusnotonlywastherea lotoftalk atFreshBegin-ningstheprogramalsoplayedhosttoacopiousamountoftalk about talk allofwhichconcertedlydelineatedtheprinciplesofinnerreference



Theprolificuseoftherapeuticmetalanguageisthefocusofchapter4ldquoAddictedIndexesandMetalinguisticFixesrdquoThechapterworkstosolveaninterestingpuzzlegivenAmericanlanguageideologywhichsystem-aticallyprivilegestheuseoflanguagetoreferencepreexistingpsychicandsocialfactswhydotherapistshavetoworksohardtoproduceprotectand patrol such highly naturalizedmdashor commonsensicalmdashideas aboutlanguageIcallsuchworkldquometalinguisticlaborrdquo(seealsoCarr2006)demonstrating thatwhereas therapeutic interventionsseemtoelicit in-nersignsthatarealwaysalreadythereawaitingcatharticescapeinlan-guage Fresh Beginnings therapy was instead an exercise in linguisticpurificationmdashonethatrequiredthelaboroftherapiststhecooperationofclientsandtheuseofparticularsemioticprocessesforproducingaperfectlycleanandsoberlanguage

Iftherapistsworkedhardtoproducethelanguageofinnerreferenceitis most obviously because they were dedicated to producing healthyspeakersNeverthelesschapter4showsthatbyformallyrestrictingtalktothereferenceofalreadyexistinginnerstatestherapistseffectivelymdashifnot intentionallymdashinsulatedthemselvesandtheiryoungprogramfromclientsrsquo critiques and challenges For instance a clientrsquos comment thattherapistsfavoredwhiteclientscouldbeswiftlyrobbedofitscriticalef-ficacyonceitwastakenupasasignofthecommentatorrsquostherapeuticallytroubling ldquoinability to trustrdquo Thus chapter 4 not only suggests thatmainstream American addiction treatment is a normative site wherebroader cultural ideas about language are practiced and policed thechapteralsodemonstratesthatprogramslikeFreshBeginningsarenorshymalizing siteswherepeople learn to represent themselves inamannerthatsupportsexistinginstitutionalandculturalorders

Therapeutic Scenes on an Administrative Stage

RhondawasoneofthoseclientsclearlynotamusedbyNikkirsquosandMar-ionrsquosanticsontheporchofthetreatmentprogramShegenerallykepttoherselfandwasoutsidethecircleoffriendsformedbymanyFreshBegin-ningsclientswhoserelationshipsweresometimesforgedwellbeforetheybegantheirtreatment(whetheringradeschoolorSundaySchoolclassesoron the street)andoftenoutlasted their stints in treatmentAccord-inglyRhondaquicklybecameaprimesuspectintheseriesofpettytheftsfromtheclient-runldquoClothesClosetrdquomdashasecondhandclothingshopsetupinthebasementofthetreatmentprogramWhethershewasactuallytheonewhomadeoffwithhighlycoveteditemsincludingthebrightlycol-oredtoddlergearwhichhadbeenmostfortuitouslydonatedbytheDis-neyStoreremainedunclear

FurthermoreRhondaparticipatedonlyinthemostperfunctorywayinbimonthlyClientAdvisoryCommitteemeetingsasemiformalmechanism



designedtogarnerclientsrsquofeedbackaboutprogramadministrationanddevelopmentShealsoseemeddecidedlyuninterestedintheregularre-portsfromthefirstgenerationofldquoclientrepresentativesrdquowhohadbeenelectedbytheirpeerstoattendFreshBeginningsadvisoryboardmeet-ingswhereprogrampolicieswereofficiallydebatedanddevelopedbytheprofessionalsaffiliatedwiththetreatmentprogramIwasthereforeabittakenabackwhenafterthefirstclientrepresentativesldquoretiredrdquofromtheirpostRhondaenthusiasticallyvolunteeredtotakethepositionWithnooneelsewillingtovolunteerorinterveneRhondabecameifonlyfora short time the soleldquoclient representativerdquoThismeant that twice amonth alongside program administrators therapists clinical supervi-sorsandsheltermanagersRhondawouldattendadvisoryboardmeet-ingsheld severalmilesaway fromCliffStreetandeven fartherawayfromthesubsidizedapartmentthatshehadjustlandedwiththesignifi-cantsupportofherHFCcasemanager

IfIwassomewhatpuzzledbyRhondarsquossuddeninterestinadministra-tive affairs my surprise multiplied when a placid and poised RhondaenteredtheboardroomforherfirstboardmeetingasifshehaddonesomanytimesbeforeIndeedshehadneverseemedmoreathomeAsmem-bers took their seatsaroundamakeshift conglomerateof institutionalfoldingtables theHFCdirectorcalledforaroundof introductions inacknowledgmentofthebrandnewboardmemberInclassicinstitutionalfashiontheprofessionalstookturnsidentifyingthemselvesbynameandorganizationalroleandfunctionwithfriendlysmilesbutlittlepersonalembellishmentAlltheboardmembersexplicitlydirectedtheirintroduc-tionstoRhondawhonoddedandreturnedsmilesuntilthecirclingdis-coursemadeitswaytoherseatFinallyitwasRhondarsquosturntoidentifyherself Without hesitation and with seemingly unimpeachable confi-dencethenewestboardmemberannouncedldquoHimynameisRhondaandIamarecoveringcrackaddictrdquoAsinanAApairstructureherpro-fessionalaudiencerespondedldquoHiRhondardquobeforeproceedingwiththerestoftheirbusiness

Chapter 5 titled ldquoTherapeutic Scenes on an Administrative Stagerdquotakesthissceneasitspointofdepartureexploringwhymodesofself-representation operant inside the therapy room affected how clientsspokeoutsidethetherapyroomaswellConsideringarangeofanalyticpossibilitiesincludingthepossibilitythatRhondaactuallyadoptedtheaddictidentitythatsheputintowordsIbringtobearLouisAlthusserrsquos(1971) and Judith Butlerrsquos (1993 1997) work to theorize RhondarsquosboardroomconfessionasaninstanceofwhatIcallldquoanticipatoryinter-pellationrdquo aprocessof anticipatinghowapowerful audience expectsonetospeakandbeckoningthataudiencetoaddressoneaccordingly(seealsoCarr2009)ComparingRhondarsquosboardroomcareertothatofan-



other client representativemdashwhoadopted the explicitly instrumentalistlingoofprofessionalboardmemberswhichIalsodescribeinsomede-tailmdashchapter5isaparableabouttheunexpectedpoliticalgainsaswellasthestrategicquagmiresofspeakingldquolikeanaddictrdquoMoregenerallyindemonstratingthatscriptsadheretoroles(ieldquoclientrdquoldquocounselorrdquoldquoadministratorrdquo)regardlessoftheinstitutionalstagesonwhichtheyareperformed(ietherapyroomboardroomshelter)thischapterexplic-itlytheorizestherelationshipofwaysofspeakingspeakersandcontextsof speechdelineatingahighlyconsequential taxonomyofpossibilitiesforldquodoingthingswithwordsrdquo(cfAustin1962)

Flipping the Script

OnecoldeveninginMarchNikkiandImetinaBobrsquosBigBoylocatedonabusystripofsuburbanboulevardforthefinalchapterofheroralhistoryinterviewIhardlyrecognizedherasshemadeherwaythroughthecrowdedrestauranttothesmokingsectionwhereIwassittingGaunteyesablazeandsportingrecentlycroppedslightlydreadlockedhairstuffedintoanoldbaseballcapshedemandedahugandIhappilyobligedCatchingbothherhandsinmineaswebrokeourembraceIconfessedldquoIrsquovereallymissedyourdquotowhichsherespondedwithanoncommittalsilence

AsidefromabrieftelephoneconversationtoscheduleourmeetingIhadnotseennortalkedtoNikkisincehertreatmenthadbeenterminatedseveralmonthsearlierbyhernewtherapistLizzyforldquofailuretocom-plyrdquoWesettledintothestickyvinylboothstillsmilinginreunionwhenNikkiaskedldquoIlookhorribledonrsquotIrdquoInuncomfortablereplyIhedgedldquoYoursquorealittlethinyouchangedyourhairrdquoTakingoffhercapasiftogivemeachancetosurveythedamagesheofferedldquoItwasjustbreakinrsquooffinmyhandcocainewilldothattoyouYouknowIrsquovebeenbackoutrightrdquoInoddedslowlyexchangingalongandloadedstareldquoYeahIsortafiguredrdquo

ldquoYoushouldreallyeatcanyoueatrdquoIqueriedremindingherofourdealmdasha$25stipendinexchangeforhertaleplusallshecouldeatattherestaurantofherchoosingldquoIshouldeatsomesaladordermeablackcoffeewithlotsofsugarrdquoNikkichargedasshepulledherselfupandheadedtowardthesaladbarIfiddledwithmytaperecorderorderedNikkirsquos coffee andwatchedas she criticallyperused thepickingsRe-turningwithaplatepiledhighwithcottagecheesepastasaladshavedcarrotsandcannedbeetssheaskedwithsomeeagernessldquoYoureadyrdquoThiswasnot thefirst time I sensed thatNikkienjoyed these recordedeventsachancetodowhatshedidmostbrilliantlytalk

ldquoOksoletmeremindyouofwhereweleftoffrdquoIrejoinedneedingnointerviewnotestogetbackoncueIndeedNikkirsquosprevioustwointerviews



had stuck in my memory like glue filled as they were with illustrativescenesandrivetinganecdotesthatgaveampleevidenceofNikkirsquostalentsasanarratorSpunwhilestillaclientatFreshBeginningsNikkirsquosfirstoral history interview oscillated between tales told seemingly to elicitshock (oftenprefacedwithldquoyoucanrsquot imaginerdquoorldquoyouwouldnrsquotbe-lieverdquo)andmovingaccountsofsurvivinglifersquosmanyblowsThesecondchapterofheroralhistory toldwhile shewasonprobation from theprogramafterhospitalnursesrevealedtoprogramtherapiststhatNikkirsquosnewbornbabyhadtestedpositiveforcocainewashighlyconfessionalladenwithclinicalexplanationsandrepletewiththekindofreligioussentiment characteristicofmainstreamAmericanaddiction treatmentNowseekingtostartwherewehadleftoffIremindedherofatouchinganecdoteshetoldmeattheendofhersecondinterviewaboutarecover-ing alcoholic ldquoJohnrdquo-turned-lover who ldquotransformedrdquo her life by lov-inglyencouraginghertoseektreatmentHerresponsetomyquerywasunnervingbuthighlyinstructive

1 I Sothatrsquoswhereweleftoff[inourlastinterview]

2 N(longpauselaughter)Ohmy(laughter)

3 I WhatWhat

4 N Itoldyouthat(laughter)

5 I Yeah(giggle)donrsquotyouremember

6 NYouknewthatdidnrsquothappenright(laughter)Pleasetellme

7 I What

8 N OhpoorolrsquoSummerson(sigh)GirldonrsquotyouknowIflippedascriptonyou

TitledsimplyldquoFlippingtheScriptrdquochapter6notonlydemonstrateshowscriptflippingtroubledtherapeuticpracticesatFreshBeginningsitalso analyzes how in performing acts of inner reference clients chal-lengedanideologyof languagethatenjoysprominencefarbeyondthetherapy roomsonCliff StreetAfter all script flippers demanded thattheiranalystsmdashwhetheranthropologistortherapist26mdashconsidertheirnar-ratives as effectual context-sensitive social actions with histories andfuturesoftheirownratherthantransparentreportsonthecontentsoftheirpsychesForexampleasthecomparisonofNikkirsquosinterviewscon-firmedherpositionintheprogram(asactiveandinldquogoodstandingrdquotoldquoon probationrdquo to ldquoterminatedrdquo) influenced the way she relayed lifeevents Wanting to convince me of her newly found faith in recoveryperhapshopingIwouldrelayittoprogramtherapistswhocouldrein-stateherhersecondinterviewwashighlypersonalizedferventconfes-sionalandclinicallyprovocativeAfterterminationhoweverNikkihadldquonothingtoloserdquoatleastfromaninstitutionalpointofviewandcon-



fessed thatherpreviousconfessionsweredecidedlyflipped (line8) InthissenseNikkirsquosoralhistory interviewkeenly illustratestheneedforanalysesthatcarefullygaugethespecificconditionsofalllinguisticper-formance(seealsoCarr2010b)Thusincreatingevidentiarycrisesforsocialserviceprofessionalsandethnographeralikemdashwhoareunabletoreadilydistinguishflippedscriptsfromldquofollowedrdquoonesmdashscriptflippingevincesboththepossibilitiesandlimitsoflanguageasameansofdetect-ingordenotinginnerstatesItalsoraisescriticalquestionsaboutathera-peuticprogramandattendantsetofinstitutionalpracticespremisedonthisculturalideal

Whileonemightlegitimatelyblametheldquopoorolrsquordquoanthropologist(line8)forhernaiveteacuteasNikkidoesabovechapter6focusesonscriptflip-pingasakindofexpertiseMorespecificallythischapterproposesthatscriptflipperswereethnographersoflanguageintheirownrightinthattheyconstantlystrovetodeciphertheconditionsinwhichtheyspokesothattheymightlinguisticallymaneuverwithinthemWorkingwithscriptflippersrsquoandtherapistsrsquodescriptionsofthepracticethechapterpursuesthequestionofhowonelearnstoflipascriptandindoingsoengagesthecurrentthinkingonmetalinguistic awarenessmdashthatistheknowledgepeoplehaveaboutthelanguagetheyspeak(egBriggs1986Jakobson1980Lucy1993Silverstein19932001Kroskrity2000)Iwilldemon-strate in particular that flipping the script was enabled by an acuteawarenessofreferentialspeechasacreativepragmaticandpotentiallyefficaciousmodeof social actionAccordingly chapter6 suggests thatmetalinguisticawarenesshasmoretodowiththeanalyticalandrhetori-calskillsaccruedinpracticethanwithanyinherentqualityofaspeechacteventorspeaker

Finallychapter6substantiatestheclaimthatpeoplecanactpoliticallybystrategicallyreproducingmdashratherthansimplyresistingmdashideologiesoflanguageForinperfectlyperforminginnerreferenceandthereforetheroleoftheldquogoodclientrdquothosewhoflippedscriptsalsodirectedtheflowofthebasicresourcessanctionsandservicesIndeedcarefulethnogra-phy explains thatNikkiwould sayanddomost anything tokeep thestatefromtakingherchildrenincludingconvincinghertherapistsnottomakethecallthatwouldhavesetthisprocessinmotionEthnographycan also show that clients bound to treatment contracts that requiredthem to attend ninety AA meetings in ninety days sometimes flippedfeministscriptsinordertokeeptheirregularshiftsattheirmenialjobsasnewwelfarelawsmandateThusScripting Addictionfollowsflippedscriptsthroughtheinstitutionalandsocialterrainsthatsooftenpunishandpenalizeinordertogaugetherewardsofthislinguisticpracticemdashwhether in the formof real resources gainedor tragic losses avoided



Onlythencanapoliticswhichistoooftenmisdiagnosedaspathologyberecognized

Method and Meaning in the Anthropology of the US

EversinceBronislawMalinowski(1922)thefatherofanthropologicalfieldworkaskedhisreaderstoldquoimaginerdquoarrivingintheTrobriandIs-lands just as he first did ethnographers have worked to demonstrateknowledgeofnativepracticesbasedontheirexperienceofbeing thereAspractitionersofaninterpretiveratherthanpositivistscienceanthro-pologistsrelyonreaderstotrustthatwehavenotonlywitnessedwhatwedescribebutalsothatwehavetriedtoseeitallthroughtheeyesofthosewerepresentevenwhenourinterpretationsdivergefromthoseofourinformants

Ethnographicrepresentationissomewhatcomplicatedwhenoneworksinaculturewithwhichthemajorityofonersquosreadersarealreadyfamiliareven if theyhavenotexperiencedfirsthand the institutionspeopleorpracticesdescribedInsuchcasestheethnographerurgesreaderstore-flect on the practices and ideas that they commonly take for grantedshowingwhatisexoticandstrangeinthefamiliarandintimateratherthantheotherwayaroundFurthermorethenativeanthropologistwhostudiesprofessionalpracticescommonlycollaboratesandcontendswithlargeanddiversecommunitiesofscholarswhoarefocusedonthestudyoftheverysamefield(egBrodwin2008Dumit2004Gal1995bGar-riott 2008 Gremillion 2003 Luhrmann 2001 Martin 1987 1994Masco2006Rapp19881990Saunders2009Young1995)Incasessuchas these the ethnographerrsquos challenge is todemonstrateboth thespecificityandtheculturalcontinuityofpracticesconceptsandinterac-tionsthatcanbeoverlookedinlarger-scalestudiesandtherebycontrib-uteuniquelytothebroaderscholarlyendeavor

Considering theexperientialand interpretivenatureofethnographicfieldwork it is understandable that audiences commonly demand toknowjusthowtheethnographerwassituatedinthefieldAccordinglythenatureofmypositionand interactionsatFreshBeginningsduringthreeandahalfyearsoffieldworkwillunfoldinthepagesthatfollowBywayofwelcomesufficeittosaythatIlearnedmyveryfirstlessonsinlinguisticanthropologyfromtheclientsandprofessionalsatFreshBegin-ningswellbeforeIdecidedtomakethesubfieldascholarlyfocusortoengageintheethnographicstudyofaddictiontreatmentForitwasasastudent internmdashworking toaccrue thefieldhoursrequired toearnmyMSWandtryingtohelptheyoungtreatmentprogramestablishitsprac-ticesandpoliciesparticularlyinrelationtoclientparticipationinpro-



gram governancemdashthat I first realized that the programrsquos therapeuticregimenwaspredicatedontalkWaitingoutsidethecloseddoorofthetherapy room where I convened weekly Client Advisory CommitteemeetingsIlistenedtothemuffledcadenceoftherapysessionsthatlastedup to threehoursOtherdays I smokedcigaretteswithclientson thebuildingrsquosfrontporchwheretherapeutictalkfrequentlyspilledoversome-times in the formof critical commentaryAndwhile I generally steeredclearofgrouptherapyinanultimatelyfutileefforttosegregatemypolicy-orientedprojectsfromtherapistsrsquoclinicalactivitiesIregularlyattendedldquospecialrdquogroupsessionssuchasthosecelebratingaclientrsquosbirthdayso-briety anniversary or advancement to the next treatment phase Evenmore frequently I foundmyselfwitness to impromptu therapeutic ex-changesbetweentherapistsandclientsmdashclientswhospentagoodpor-tionoftheirwakingweekdaystalkingaboutthemselvesonCliffStreet

TheseearlyexperiencesnotonlyprovidedthefirstofmanylessonsIlearnedonCliffStreetandfurtherfueledmyinterestinpursuinggradu-atetraininginanthropologyTheywerealsothewayIgainedaccesstoplaces and people described in this book Furthermore once my jobshiftedfrominfluencingprogrampolicyandpracticesasafledglingsocialworkertodescribingandanalyzingthemasanethnographerIalsobe-cameresponsibleforrepresentingthesometimesconflictingandalwaysfascinatingperspectivesofthoseIstudiedwhetherprofessionalpracti-tionersorclientsTothatendthepagesthatfollowquoteverbatimfromthedozensofrecordedinterviewsIconductedduringthecourseofmyfieldwork I also make use of data collected over countless hours ofparticipantobservation including the informalconversations Ihadonthefrontporch inthetherapyroomoraroundtheboardroomtableThetrustIestablishedwiththeprofessionalpractitionersaffiliatedwithFreshBeginningsisdemonstratedbythescoresofprogramdocumentsmdashincludingmeetingminutesgrantapplicationse-mailstocolleagueslet-ters to clients and supervisors training materials and group therapyplansandworksheetsmdashthattheygavemetoaidmyeffortstounderstandand analyze their practices The trust I established with the clients ofFreshBeginningsisdemonstratedbythefactthattheytaughtmethatthediscoursecontainedintheseinstitutionaldocumentscouldbeldquoflippedrdquototheiradvantageAndwhetheritindexedagrowingintimacybetweenusorsimplyapragmaticinvestmentinteachingmeaboutthesemioticandpoliticalquagmiresentailedinbeingaFreshBeginningsclientNik-kirsquos suggestion that she had flipped my very own professional text mdashnamelytheethnographicinterviewmdashwassimplyinvaluableForatthatmomentIunderstoodthatmychargeasanethnographerwastoaccountforthecomplexitiesofspeecheventshowevermuchImyselfwasimpli-catedorinvolvedinthem



ConsideringthemeaningfulinvestmentsofthestaffandclientsofFreshBeginningswhichyieldedsuchmultidimensionaldatamyresponsibilityistoelucidatetheperspectivesoftheprofessionalpractitionersandcli-entsaffiliatedwiththeFreshBeginningsprogramwithoutconcedingmyownAsMarilynStrathern(1988)oncewrotethegoalofethnographicdescriptionistosetupparallelworldsinwritingwhichbothdescribesinformantsrsquowaysof settingup theworldas theydoand indicates theethnographerrsquos interests in construing the world as she does keepingtheseperspectivesanalyticallydistinct

Sowhereasananthropologistmayinitiallywonderwhattheethnogra-phyofanaddictiontreatmentprogramcanofferthestudyoflanguageuseandideologyandaprofessionalpractitionermaydoubtthatlinguis-ticanthropologycanshedmuchlightonthepoliticsandpracticesofthemanysuchprogramsacrosstheUSwhereshemightfindherselfatworkmyintentioninScripting Addiction is todemonstratethatmainstreamAmericanaddictiontreatment isaparticularly illuminatingsitewheredominantculturalideasaboutlanguageareputintoconcertedpracticeIn drawing attention to the labors needed to sustain even the mostnaturalized linguistic ideologiesaswellas thesurprisingstrategiesde-ployedtotrumpthemthebookalsoshowswhyonemustunderstandthepoliticsoflanguageinordertoappreciatethecomplexstakesofclinicalinterventions ThatsaidScripting AddictionisnotaprescriptivebookbutinsteadadescriptiveandanalyticaloneAndalthoughIfirmlybelievethatcarefuldescriptiveanalysisisanessentialbuildingblockofanysuccessfulinter-ventionit isbeyondthescopeofthistexttoprescribewhataddictionprograms should be like or for that matter how social service boardmeetings shouldbe run shelter intakes conductedormechanisms forclientparticipationinstitutedAlthougheachoftheseimportantprofes-sional practices is described and analyzed in the following chapterssometimesquitecriticallyIleavetheimportantworkofrevisingrevamp-ingorimprovinguponthesepracticestothemanyothersdevotedtothisimportantworkmdashsomeofwhomIhopewillbeinfluencedbythisbookIntheconcludingchapter Idescribesomeexistingattempts todo justthataswellasthebroaderimplicationsofthisbookbothforstudentsofcultureandlanguageandforprofessionalsocialworkstudentsIn-deedScripting Addictionrsquos mostpracticalhopeistosuggestthatthesetwobodiesofstudentshavemuchtolearnfromeachotherForasFreshBeginnings professionals and clients poignantly demonstrate both ad-ministrativepracticesandtherapeuticideasarethoroughlyculturalandinexorablypoliticalAndintheendScripting Addictionwillremindthereaderthatcultureandpoliticsarealwayssubjecttochange


2 bull Introduction

youalsodependonthespecialiststodeterminehowmuchmoreyouwillsufferwhichtheywilldiscernasyoutrytospeakinthewaystheyhavetaughtyouForasritualformulasthemantrasyouhavelearnedfromthespecialistscantransformaswellascondemnyouintheeyesofthelocalsItalldependsonhowyouusetheseefficaciouswaysofspeakingwhich the specialists will evaluate and oversee but can never totallycontrolIndeedhowwilltheyeverreallyknowifyouhavetrulyldquogonenativerdquo and been transformed by their treatment And what are thestakesnottomentionthepossibilitiesofdoingso

WelcometotheworldofmainstreamAmericanaddictiontreatmentwherediseaseisconceivedassomanyillegiblesignsthatcanonlybereadbythesober

Treating Talk and Talking Treatment

This book is based on more than three years of following an inter-connected group of professional practitioners1 and drug-using clientsthroughanetworkofsocialserviceagencies inaMidwesterncitythatwas(andstillis)sufferingtheeffectsofeconomicdownturndisinvest-mentandwelfarestateretrenchmentTheethnographyfocusesonldquoFreshBeginningsrdquomdashanoutpatientdrugtreatmentprogramatthecenterofthissocial servicenetworkmdashandtheassociationsandnegotiationsbetweentherapists and clients there As suggested above these everyday inter-actionsweresemioticentanglementsclientsworkedtoeffectivelyrepre-sentthemselvesandtheirproblemsandtherapistsworkedtoscriptorset the terms of these representations Because of the institutionalizedtiesbetweenFreshBeginningstherapistsandothersocialserviceprofes-sionalsavarietyofresourcesmdashfromtemporaryhousingtransportationvouchersandjobtrainingtomedicalcarelegalprotectionandthera-peuticacknowledgmentmdashhung in thebalanceof these intensiveverbaltransactions

ScriptingisanespeciallyimportantifpoorlyunderstoodelementofAmericansocialworkamultidisciplinaryfield inwhichpeoplersquos sym-bolic interactions have far-reaching material consequences2 While thecoerciveandcontrollingnatureofsocialworkandwelfarepracticeshasbeenwelldocumentedScripting AddictionillustratesthatsocialserviceprofessionalstalkaboutpeopleandproblemsinwaysthatresonatewithbroaderculturalnarrativesandtherebyappealtopowerfulinstitutionalaudienceswhocanhelpthemtohelpothersAfteralladdictioncounsel-orscaseworkersandsheltermanagersmdashliketheonesportrayedinthisbookmdashdonotsimplyevaluateclientsrsquowordsassignsofpersonalprog-


Introduction bull 3






4 bull Introduction





Introduction bull 5





6 bull Introduction


Text and Territory






Introduction bull 7



HUD

HFC



Fresh Beginnings

$$$



8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























Introduction bull 3






4 bull Introduction





Introduction bull 5





6 bull Introduction


Text and Territory






Introduction bull 7



HUD

HFC



Fresh Beginnings

$$$



8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























4 bull Introduction





Introduction bull 5





6 bull Introduction


Text and Territory






Introduction bull 7



HUD

HFC



Fresh Beginnings

$$$



8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























Introduction bull 5





6 bull Introduction


Text and Territory






Introduction bull 7



HUD

HFC



Fresh Beginnings

$$$



8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























6 bull Introduction


Text and Territory






Introduction bull 7



HUD

HFC



Fresh Beginnings

$$$



8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























Introduction bull 7



HUD

HFC



Fresh Beginnings

$$$



8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























8 bull Introduction





Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What
























Introduction bull 9


















































Flipping the Script










3 I WhatWhat




7 I What




































































Flipping the Script










3 I WhatWhat




7 I What




























3 I WhatWhat




7 I What























Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety

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Transcript of Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety