The Pastoral Clinic: Addiction and Dispossession along the Rio Grande

Just before her 29th birthday, Alma was found in the parking lot of an emergency room, left there by loved ones who feared she might die from a heroin overdose. The local drug court sent Alma to Nuevo Día, a clinic that she had discharged herself from before. Alma had been in recovery programs six times and detoxification clinics twice in the last five years. Garcia explains that Alma’s story is common, part of the recidivism perpetuated by a cultural understanding of addiction as a chronic illness. Two years after her encounter with Alma, Garcia learns that Alma has died after overdosing on heroin.

Garcia explores addiction within the context of loss, arguing that the two are intrinsically linked. The researcher uses Alma’s life to explore the idea that unresolved grief and addiction are connected, sharing what she learned about Alma’s history and life after Nuevo Día. She feels it is important to honor Alma’s story and character: “Alma as she appeared to me—generous, reflective, and deeply engaged in trying to find a way to live” (72).

After finishing her 30 days of detoxification, Alma finds a room at a halfway house. Garcia visits her and takes her to the local library, where she tells Garcia about her older sister who died after being hit by a drunk driver. She says that a handmade descanso marks the spot where her sister died and that she saw this marker each time she drove to her dealer’s house. One understanding of grief is its repetitive nature. There is no separation between living and dead, causing bereaved individuals to live out their losses over and over. Garcia suggests that this repetition is not healing but instead intensifies grief.

Alma returns to the clinic after heroin is found in her system during a routine drug test. She shares her story with Garcia, who records it. She intentionally and repeatedly tried to overdose on heroin after her sister’s death. In the transcript, Alma explains that she knows she will relapse again; it is inevitable. Her loss is embedded in every part of her life.

Garcia suggests that this is partially related to the land and its history. Garcia visits Tierra Amarilla where Alma grew up. As the few remaining villagers leave on weekdays to commute to Los Alamos for work, Tierra Amarilla becomes a ghost town. First settled in the mid-1600s, a land grant gave Mexican settlers homes and farmland. Common lands were also allotted that could be shared as collective property. When New Mexico was absorbed into the United States in 1848, farmers and workers lost their land rights. Alma tells Garcia that she does not want to visit Tierra Amarilla and that there is nothing there anymore. Garcia notes how Alma’s losses intersect.

Alma discharges herself from the clinic after three days, citing insomnia. A few days later, she calls Garcia and tells her that she still has not used heroin. She invites Garcia to visit her at a local church, where she has found a recovery program that she likes because it focuses on the future rather than the past. She explains that remembering forces her into relapse.

When Alma later dies, Garcia visits her husband, Luis, and he shows her a descanso that he placed among the trees for his wife, close to the home where she grew up.

Garcia emphasizes that melancholy is a moral reaction to loss that stands in opposition to the escape offered by drug use. For the Latinx community in the region, the loss associated with colonization, poverty, and war is resurrected at every turn. Older generations worry that younger generations are forgetting their historical roots, while younger generations feel a need to escape from the past. The constant presence of historical scars leaves individuals feeling like their suffering is never-ending.

While participating in a consortium, Garcia learns about the equity challenges in Santa Fe, Los Alamos, and Rio Arriba. While Los Alamos was thrust into wealth with the expansion of the Los Alamos National Laboratory (LANL), the other two regions saw an increase in poverty and a loss of land. As Garcia travels to Los Alamos, she sees descansos every hundred feet along the highway, as well as abandoned adobe homes.

The chapter closes with Joseph’s story. After 30 years of heroin use, Joseph reaches his four-year mark of recovery. He lives in a trailer park, and his son, Ricky, visits him on the weekends. Joseph tries to make his trailer nice for him and Ricky. He tells Garcia that when he was in prison and using heroin, he had no incentive to care for himself, others, or his surroundings. Joseph exhibits melancholy, speaking often of his past and the land on which he was raised. Garcia notes that as he shares his story, he switches between past and present tense, blurring the lines of time. She argues that Joseph finds meaning in his everyday experience by living with and engaging with the past rather than running away from it. Although this endows him with a sense of sadness, confronting his past offers a form of liberation.