In Righteous Dopefiend, the anthropologists Philippe Bourgois and Jeff Schonberg present their findings from over 10 years of ethnographic research within the Edgewater community, a group of homeless heroin addicts living at the margins of San Francisco. Following the lives of almost a dozen main characters, or the ‘lumpen’ as the author terms them in a revival of Marxist terminology, we witness the symbolic and structural violence that they experience on a daily basis. As one would expect in a book of this sort, there are graphic representations of drug use, violence, and ill health; but more than that come detailed descriptions of the everyday details of what it is to be a homeless drug user. Bourgois and Schonberg describe how there is an almost honour among the substance-addicted, how addicts are duty bound to help another member of their community who is experiencing symptoms of withdrawal by sharing what little heroin they have.
Access to health care, especially substance misuse programmes, makes up a significant portion of the book. Leaving aside the idiosyncrasies of the US health system that seem to throw up barriers that even the most seasoned NHS bureaucrat may find baffling, the politics of biopower (a term used by Michel Foucault ‘… to refer to the practice of modern states and their regulation of their subjects through “an explosion of numerous and diverse techniques for achieving the subjugations of bodies and the control of populations”’)1 and opiate substitute therapy is truly revealing. As one homeless veteran, Frank, remarks, ‘They got complete control of your fucking life … That’s why I never get on maintenance [opiate substitute therapy] again. It’s like being in prison. I can’t stand that. They got you scared all the time… And then when they get a little hair up their ass about something, they gonna cut you down. And that shit, is life and death man.’
This book is one of the most powerful and detailed accounts of heroin use of the homeless. For practitioners involved in the care of homeless or substance misuse patients, it is particularly poignant and provides an invaluable perspective from the other side of the consulting table.
- © British Journal of General Practice 2018
REFERENCE
- 1.↵