Richard Bright: Can we begin by you saying something about your background?
Joshua Burraway: I’m an anthropologist. If you wanted to narrow things down a bit more I’d probably be described as a medical anthropologist, if only because the areas of human experience that I’m interested in – substance-use and mental health – are deeply connected to the world of biomedicine and health more broadly. I was trained, from undergraduate all the way to my doctorate level, at University College London. The department is well-known for being something of a broad church, meaning that you’re trained in biological, sociocultural, and material anthropology. In other words, you got a chance to dip your toes in a pretty large range of anthropological sub-genres before narrowing down your research interests as you progress. Fundamentally, though, whichever disciplinary subset you end up in, the key methodology of anthropology is ethnography – meaning that you spend long periods of time hanging out with the people you study, immersing yourself in their worlds and attuning yourself to their realities. My doctoral project saw me conduct sixteen-months of ethnography amongst a community of homeless drug-users in East London, with an analytic focus on the structural and existential components of drug-induced altered states, notably the blackout (not to be confused with passing out). Since then, I’ve moved over to the US to teach at the University of Virginia, where my current research focuses on the social, political, and temporal dynamics of the opioid crisis in rural Appalachia. Having spent last year teaching in UVa’s anthropology department, I am currently undertaking a research fellowship at the Institute for Advanced Studies in Culture.
RB: What is the underlying focus of your work?
JB: Throughout my career so far, I’ve consistently tried to problematize biomedical understandings of addiction and mental health, especially as they arise in contexts of vulnerability – my work amongst the urban homeless being the best example to date. In this body of work, I’ve looked to explore how the local lifeworlds of the urban homeless, and more specifically their substance-usage and mental health issues, have been shaped by global forces of structural violence and systemic inequality. In this sense, I ask how different forms subjectivity – in particular altered states of consciousness induced through drugs and alcohol – have become entangled in broader dynamics of social defeat and chronic poverty, leading homeless drug-users to become internally othered through a combination of carceral politics, police surveillance, biopolitical therapeutics, and exclusionary legislation. These, I think, are important themes to pay attention to, especially as the twinned phenomena of addiction and mental illness continue to tighten their grip on the world’s most impoverished communities. As things currently stand, these complex forms of suffering are mostly made sense of through individual-centred disease models, as though addiction and mental illness are somehow unrelated to the existential conditions of a person’s social and material environment. Accordingly, a focus of my work has been to challenge these models as an inadequate account of the suffering they purport to explain.
Of course, I am by no means the first social scientist to become preoccupied with these questions – far from it! That being said, my analytical approach to these issues has emerged from a distinct theoretical milieu from within anthropology – phenomenology, or more specifically temporal phenomenology. Rooted in continental philosophy, phenomenology can be understood as an explanatory model that seeks to reveal the structure and conditions of lived experience by articulating how the world appears and is felt from an embodied perspective. Rather than trying to argue for and prove some preconditional “logic” of reality, phenomenology attempts to trace the ways that a person’s experience of the world around them – their very “being-in-the-world” – emerges out of their intrinsic entanglement and submersion in a world that always already matters. From this perspective, meaningful existence does not emerge out of some a priori set of facts, but rather from the situational possibilities that emerge via the dynamism of a relational world in constant motion. A temporal phenomenology emphasises the inexorable role of time in the constitution of lived subjectivity, intersubjectivity, and internal consciousness – foundational of being itself.
Why, you might understandably ask, is this relevant to a study of homeless addiction? Well, the answer I would offer is that all forms of social suffering – such as addiction and homelessness – are constituted by complex forms of temporality; forms that simultaneously cut across the social, the political, the psychological, and the somatic. In short, to be a rough sleeper means existing in a particular realm of time – one that feels bloated and sticky, dislocated as it is from the “productive” regime of consumer time, regular employment, and domestic routine. Theirs was thus a realm of time endowed with an endless, undiluted quality – emptying the present of eventfulness and foreclosing the future of meaningful possibility. Haunting this swollen present were memories of intimate losses and personal humiliations, dogging them as they went about their daily lives. Under these conditions, time was framed by my homeless interlocutors as a kind of insatiable beast that was forever threatening to eat them up. As such, time needed to be killed before they were swallowed by it. And few things kill time better than drugs and alcohol, their unique biochemical architecture – not to mention their inexpensive abundance on London’s streets – making them the perfect technology for inducing altered states-of-consciousness; states that followed a radically different temporal logic. In Itchy Park where I conducted the majority of my fieldwork, the most consistently induced altered state amongst my homeless interlocutors was the black-out. Realising that there is very little written in the social sciences on the subject of drug-induced blacking-out, this anaesthetic state-of-being has become the primary analytical focus of my work. Since then, my prolonged phenomenological exploration of this state that has enabled me to connect the lived experience of the black-out to broader theories of morality, autonomy, and political economy.
RB: You mention your research examining the relationship between anaesthetic intoxicants, memory, forgetting and subjectivity among homeless addicts in inner-city London. In particular, the dissociative journeys into drug-induced blackouts. Can you say more about this?
JB: I certainly can – though I might start off with the insufferable trait of answering a question with another question. Or rather, questions, in this case. Anthropology, after all, tends to be much better at digging up questions that offering out answers – perhaps to a fault. In this sense, I suppose I’m reverting to type! Nevertheless, I think the following questions can help frame the scope and scale of my research interests. At the very least they’ll help me, as requested, say more:
What happens when the supposedly synthetic link between past, present, and future, anticipation and memory, begins to break apart? What does it mean to exist as a being without memory? What does a sense of time look like in the absence of memory? If such a being does exist, what does it tell us about the role of memory in the constitution of subjectivity, of temporality?
Where these kinds of questions might have traditionally been the preserve of continental philosophy and more recently cognitive neuroscience, they are, from my perspective, fundamentally anthropological questions also – not least of all within the uniquely human arena of addiction. As you can probably already guess, there is one bodily state within which all the aforementioned questions coalesce: the blackout. For the homeless substance-users whom I worked with, it was the blackout that emerged as their most radical daily ritual; a means not only of stepping out time, but also out of self. In short, it was a way for them to “become somebody else” – a memoryless, dissociated state-of-being that was at once their primary means of escape and also their most impenetrable prison.
In order to better grasp this paradox, you first need to grapple with the existential realities of street addiction, paying particular attention to the multiple scales of time that are plaited into the situational conditions of homelessness. My research considers these scales on two principal levels. Firstly, it emphasizes the temporal configurations of street homelessness, arguing that the precarity of these conditions is deeply connected to a kind of temporal bracketing – that is to say, my interlocutors experienced their homelessness as a kind of swollen present that was flanked on one side by a painful, often tragic past and on the other a future that had all but been evacuated of meaningful possibilities. In other words, their temporal conditions were connected not only to diffuse forms of structural violence, but also to intimate personal losses; be that the death of loved ones, divorce, family estrangement, sexual abuse, or incarceration. Teasing out the relational voids and structural abuses that are braided into the temporal realities of homeless addiction is a distinctive element of my research. Further, it is this analytic framework that enables me to connect the “bracketed” temporality of street homelessness to the pharmacological oblivion my interlocutors sought on a daily basis. Surrounded by the haunting echoes of ghosts that were at once structural and intimate, my core argument is that my interlocutors turned to anaesthetic intoxicants – predominantly alcohol, opiates, synthetic cannabinoids, and benzodiazepines – as a way to kill two birds with one stone. For one, the psychoactive substance provided a surrogate bond that stood in for the absence of those relationships that had been lost or damaged. On top of that, it was precisely through this bond that they were transported into the anaesthetic realm of the black-out – an embodied temporality in which the traumatic memories of loss and pain were allowed (along with their agency) to go on behind their back.
Whilst there is some clinical and psychiatric literature on the black-out state (it has historically been viewed as a “phase” within the broader neuro-pathology of alcoholism and drug addiction) there is, as I said earlier, precious little written about it anthropologically. By drawing extensively on temporally-oriented frameworks from within anthropology, sociology, and philosophy – I have attempted to theorise the homeless black-out as an ontological, rather than pathological, category –a way rather than a waste of being. Such a move hinges on exploring the complex interface between memory and forgetting that takes place within existential processes of self-making. Further, the long-term ethnographic component of this research ensures that these processes are embedded in their proper situational context – that is to say extreme socioeconomic precarity coupled with constant biopolitical surveillance. For my interlocutors, forgetting themselves through black-out constituted not only an erasure of self and circumstances, it also summoned an alternative body-being into the vacuum left by the chemically-induced flight of their memories – what many of them referred to as “becoming somebody else.”
A central claim of my argument, then, is that the “somebody else” that emerges from within the amnesia of the black-out enjoys an ontological status closer to that of a possessive spirit or ghost; an external, labile force that arrives under the cloak of chemical oblivion to claim a person’s body and agency – hijacking their being-in-the-world, as it were. In this way, the black-out emerges not only as a creative mechanism for coping with and resisting the lumpenizing effects of neoliberal adjustments to welfare, housing, and economy, but also as a challenge to the conventional parameters of what it means to be a person.
By conceptually aligning the black-out with the agentive multiplicity of sprit possession, the bounded individuality of the Western subject – with all its intrinsic connections to personal responsibility and neoliberal autonomy – no longer appears so self-evident. The reductionist interpretations of biomedicalized pathology hinges on this same, fundamentally limited model of subjectivity. It is limited because it cannot (without reaching for the black-box of psychiatric disorder) account for those who experience multiple subjectivities lying latently within a single body. The anthropological analysis offered in my research tries to offer an alternative account of things. As a way to escape existential crisis and (however briefly) become another self, the black-out emerges as a simulacrum of the kind of “ego loss” healing techniques once provided through institutionalized ritual, the decline of which in the West can be linked to the ascendancy of individual-centred biomedical therapeutics. It remains a simulacrum because, for all its transformational promises, inducing the black-out state remains an individual endeavour, the extreme isolation of homelessness meaning that they are, in yet another neoliberal twist, forced to take responsibility for their own healing. This irony, I argue, is manifest in the paradoxical form of the black-out itself: that is, one exists as an absence rather than living as a presence, the escapist possibility of “becoming other” forever held just out of memory’s reach. In other words, the moment one returns to memoryful sobriety, the very crisis that demanded such a radical existential shift comes roaring back – often with interest.
RB: How much does boredom and/or the desire to ‘become somebody else’ play in these drug-induced blackouts?
JB: Boredom and the “somebody else” of the black-out are inexorably linked, two sides of the same coin, so to speak. If anything, you could argue – and I do – that boredom is one of the primary motors driving the escapist transition into black-out. Crucially, though, when my interlocutors articulated their street homelessness in terms of boredom (which they did on a daily basis) it’s worth noting that this wasn’t the kind of boredom we might experience when waiting for a plane to board, or a traffic jam to move. Rather, they were articulating something closer to the conditions of “existential boredom” – described by philosopher Lars Svendsen as a vacuity of the soul, where life and meaning are drowned beneath wave upon wave of undiluted time. As I’ve said earlier, the waves of time they were submerged beneath not only confirmed their de facto exclusion from the rhythms of productive employment and normative social life, they were coursing with painful memories of intimate losses and personal humiliations – the ghosts of their past filling the emptiness of bored time and haunting them as they went about their daily lives.
In a nutshell, I make the case that these ghostly, melancholic forces entrap the homeless in a kind of existential crisis – a crisis that, for some, is (temporarily) solved through dissociative journeys into the “somebody else” of the drug-induced blackout. Emphasising the need to move beyond the reductionist accounts of the black-out currently buried in the clinical literature, I’ve tried in my work to establish a new conceptual framework for this phenomenon, drawing extensively on the work of Italian ethnologist Ernesto Di Martino – notably his theories of institutionalised ritual and existential presence. Facing a “crisis of presence”, but with neither the collective ritual structures nor the sacred figures who have traditionally regulated these arenas available, the burden of ritualization, I contend, falls squarely at the feet of the homeless. In this way, I argue that the blackout can be understood as a kind of auto-salvage operation where the homeless must use their foremost instrument – their body – as a transformative and ritualizable medium unto itself. On the streets, these acts of “DIY-transformation” typically result in extensive periods of drug-fuelled anaesthesia, in the process creating novel forms of bodily metamorphosis that simultaneously defy and attract varying regimes of social control.
In this way, I conceive “becoming somebody else” through blackout to be a reinvention of self, not unlike the kind of transformation that the late, great anthropologist Roy Wagner explored in his ground-breaking work on healing rituals amongst the Daribi of Papua New Guinea. Using what’s known as obviational analysis, Wagner explores the habu ritual in which Daribi men become the ghosts that are said to afflict people with illnesses, in the process enacting a curing. Put briefly, obviational analysis requires that already established meanings are overcome, or perhaps dissolved in Wagner’s terms, so that something else, something “inventive” and other can appear. Wagner’s (and indeed Di Martino’s) genius was to reconceptualise ritual as an improvisational enterprise in creative, even revolutionary power. Returning to the habu, Wagner argues that this whole becoming ghosts business is not about obeying the demands of cultural convention; rather they improvise with the ontological “givens” they have to hand, a process that capsizes “innate” distinctions (in this case the distinction between living bodies and dead ghosts) to produce a curing that is profound and effective because it rearticulates the categories that they take for granted. In these moments of category cross-over, in which habu men become ghosts, the dead are brought to life in their interactions with living people. This then, as far as I understand it, is the power of the habu – to turn convention inside-out and thereby produce or “invent” a novel social reality, one in which ghosts and men can occupy the same body. My former UCL professor, Martin Holbraad, offers a wonderful exposition of Wagner’s ideas in his recent book, The Ontological Turn (co-authored with Morten Pedersen).
My argument (one that I’m developing in my current book) is that something similarly obviational or reinventive might be seen as happening at the embodied level of the blackout when the existentially bored homeless of Itchy Park try to resolve their crisis-of-presence by living as an absence, as “somebody else.” It is reinventive in Wagner’s sense insofar as it takes certain conventional assumptions – namely that we are bounded, individual selves who move through time in a linear trajectory, from past into present into future – and through intoxicants, turns them inside-out, thereby transforming the meaning of the terms involved. Contained within the simple statement “I become somebody else”, then, is a metamorphosis of meaning that is unique to the abject temporal and social conditions of street homelessness: the possibility that, while existing in the present, the Self (“presence”) may also become simultaneously lost and Other (“absent”). What’s crucial, in my opinion, is just because this “other self” does not exist within the reproductive realm of memory, this does not mean that it should forfeit its ontological existence, which is exactly what happens when the black-out is reduced to an individual neurological pathology. My central claim, then, loosely stated, is that the homeless, faced with the intimate-structural ghosts haunting them, respond by chemically reinventing themselves into a kind of ghostly alterity – becoming other unto themselves.
RB: Precarity is an existence lacking in predictability, job security, material or psychological welfare. The social class defined by this condition has been termed the precariat. In his book, The Precariat, Guy Standing warns that the rapid growth of the precariat is producing instabilities in society and that it is a dangerous class because it is internally divided, leading to the villainisation of migrants and other vulnerable groups. Do you agree with this assessment?
JB: I do. Indeed, I think this question of internal splintering is worth paying serious attention to. What maybe sometimes gets neglected, though, is the way that this sense of division can manifest itself within the same vulnerable groups who all too often find themselves at the sharp end of this fragmentation process. For example, amongst the predominantly white British homeless group I hung out with in Itchy Park, those who had ancestral links to the local area would often speak wistfully about the loss of “the real East End,” often pointing to the adjudged influx of young men from Eastern Europe and the Bangladeshi diaspora. It wouldn’t be uncommon for these men to be cast in the mould of invaders who were seen as flooding the country’s overly porous borders to deliberately undercut the labour market, steal social housing opportunities, drain healthcare resources, and more generally abuse the generosity of the UK’s civic resources. Given that I conducted my fieldwork in the two years building up to the Brexit vote, it isn’t hard to see how these kinds of assessments reflected the xenophobic discourse that was building up a head of steam at the time, one that continues to trade in the currency of scapegoating, fear, displacement, and thinly-veiled white nativism. For me, what makes these sentiments especially dangerous was the way they became so readily internalised amongst some of my interlocutors, in the process deflecting attention from the real cause of their vulnerability and destitution, namely the gaping structural fault lines in the neoliberal economic order. Within the “grey-zone” of homelessness, precarity fosters social conditions in which the most vulnerable people either turn on each other, or else are forced to turn on themselves and become personally responsible for their own situation and future wellbeing – dragging themselves up through their bootstraps, etc. – as if systemic constraints and global transformations in labour and economy somehow don’t matter. Under these precarious conditions, social problems become metaphorically transferred onto so-called “problem people”, leading to a myopic focus on the behavioural adaptions that emerge in response to extreme poverty rather than its systemic roots. I suppose, then, that what makes the precariat such a dangerous class is that no one is safe.
RB: What are the concepts of ‘moral economy’ and ‘lumpen subjectivity’ in reference to indigent addiction?
JB: These concepts stem from the seminal work of Philippe Bourgois, an American sociocultural anthropologist who has carried out ground-breaking ethnographic work amongst vulnerable and often demonised social groups, including homeless heroin users in San Francisco and Puerto Rican drug dealers in New York.
Bourgois develops the notion of the “moral economy” to describe the web of reciprocal sharing and mutual obligations that set the parameters for intersubjective relations within social environments constituted by extreme scarcity and chronic poverty, such as within homeless encampments. Amongst Bourgois’ homeless heroin users, as in Itchy Park, how you share and whom you share with are the primary social fail-safes against the threat of withdrawal, thereby ensuring that drugs and alcohol are inseparably bound up within the park’s economic and moral fabric. The complexities of this network are deeply entrenched within the daily struggles of homeless living. Ultimately, the point is that these mutual relations of exchange and care are built on the shared experiences of addiction and withdrawal, such that it is practically impossible to disentangle the long-term human relations within the park from the drug relationships that underpin them. This is not to deny or trivialize the intimacy of these intersubjective relations; rather, it is to embed their formation within a chaotic and traumatic world where the strongest relational bonds are often between drugs and people. What’s more, the scarcity within which these relations unfold is underwritten by what Bourgois describes, via Primo Levi, as the logic of the “grey-zone” – which is to say that the need to help others is continuously set against oftentimes brutal cost–benefit analyses that can never leave everyone satisfied, ensuring that care and betrayal remain intimate bedfellows.
The notion of “lumpen subjectivity” relates to Bourgois’ reframing of an old Marxist concept. In Marx’s usage, the lumpen were those people structurally positioned just below the wage worker, propping up the system through irregular employment. In Bourgois’ reworking, lumpen takes on an evolved meaning – employed to describe those vulnerable groups for whom punitive forms of disciplinary governance – such as through surveillance, policing, and incarceration – have become destructive and alienating, even as other segments of the population – notably transnational corporations – continue profit from these systems of abuse and punishment. In Bourgois’ eyes, so rigged is the American economy in the favour of corporate power and special interest groups, so imbalanced and underfunded are their social care services, and so championed are the principles of individual responsibility and free market bootstrapism, that an ever-growing number of America’s indigent classes (a disproportionate amount of whom struggle with addiction issues) are subject to the process of lumpenisation. This process, complicit with the gaping health disparities we see between the upper and lower classes, not only exacerbates the suffering of these vulnerable groups and damages their bodies, it reshapes the bounds of their subjectivity to the point where everyday forms of systemic and intimate violence are experienced as the natural order of things. Notwithstanding the more egalitarian structure of the UK’s healthcare system, time and time again I witnessed a similar process of lumpenisation acting upon the subjectivities and bodies of my homeless interlocutors.
RB: Your current ethnographic research is on the opioid crisis in rural Appalachia. Can you say more about this?
JB: Working alongside my colleague at UVa – anthropologist China Scherz – we’re trying to shine a much-needed ethnographic light on the current epidemic, focusing specifically on low-income communities in the Appalachian region of Southwest Virginia and Eastern Tennessee. As social scientists have shown across the world, places that have suffered from deindustrialisation and subsequent socioeconomic neglect have led many people not only to lose hope of a better future but also hope in their relationships with their families and communities. Our study is interested in exploring how people living under such conditions negotiate relationships of trust and futurity, focusing on the role that opioid analgesics and addiction treatment programs play in these processes. Anyone with half an eye on the news will probably be aware that opioid addiction and overdose rates in the United States have skyrocketed in the last twenty years, the proliferation of prescription opioids that began in the 1990s having hit former coal mining communities especially hard.
Essentially, we’re studying how these substances have affected people’s lives, social networks, and sense of the future. In conjunction with that, we’re also examining the effects of three therapeutic interventions: medication assisted treatment (MAT); Narcotics Anonymous; and faith-based programs. We want to know how these different interventions influence people’s sense of future possibility and their perceived pathways to recovery. Further to that, we’re interested to see whether religious and clinical therapeutics in this context are necessarily mutually exclusive. We decided to base this study in the Appalachian region because of the deep intersection of deindustrialization and rural poverty, its higher than national overdose rate, along with its distinctly Christian religious landscape.
More broadly, we feel that this research might provide a model for addressing questions of hope and temporality in clinical and social scientific studies of addiction. This study will also provide the first sustained ethnographic analysis of how spiritual transformations relate to opioid addiction and recovery in an Appalachian context, illuminating the way that religious practices intersect with the historical, economic, sociopolitical, and embodied trajectories of the current epidemic. Finally, through its potential to offer insights into other ways of conceptualizing addiction, we feel that this study will contribute to a growing body of literature that seeks to think beyond the increasingly dominant medical model of addiction as a chronic relapsing brain disease. While MAT remains a valuable and hard-won therapeutic avenue for those afflicted, recovery, like addiction itself, does not emerge in a social vacuum. Indeed, rebuilding meaningful social connections and a sense of trust in the future may be just as important an aspect of recovery as mediating physical withdrawal symptoms. Our study aims to offer new insights into the mechanisms through which these social connections could be built and to lay groundwork for improved collaborations between addiction practitioners who may see their approaches as fundamentally at odds.
 Arguably, the most accomplished anthropological take on these kinds of themes has been Angela Garcia’s ground-breaking work, The Pastoral Clinic. In her work amongst Hispanic heroin users in New Mexico, Garcia explores melancholia, or endless mourning, as a mode of historicity that sits at the intersection of historical tragedy, land appropriation, rural poverty, and intimate loss. This is a world where past suffering intertwines with heroin addiction and biopolitical therapeutics to amplify the melancholia, stunting future possibilities but also creating a feedback loop where the temporality of heroin use blunts the very future it helps to bring about.
 For anyone who wants to take a deeper dive into the situational conditions driving the current war-on-drugs, look no further than anthropologist Jarrett Zigon’s excellent recent book, A War on People.
 Whereby opioid addicts are prescribed non-euphoric synthetic opioids that help them abstain from illicit opioid consumption without the damaging physical and psychological consequences of withdrawal.
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