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3 Introduction The popular medical formulation of morality that goes back to Ariston of Chios, “virtue is the health of the soul,” would have to be changed to become useful, at least to read: “your virtue is the health of your soul.” For there is no health as such, and all attempts to define a thing that way have been wretched failures. Even the determination of what is healthy for your body depends on your goal, your energies, your impulses, your errors, and above all on the ideals and phantasms of your soul. Thus there are innumerable healths of the body; and the more we allow the unique and incomparable to raise its head again, and the more we abjure the dogma of the “equality of men,” the more must the concept of normal health, along with a normal diet and the normal course of an illness, be abandoned by medical men. Only then would the time have come to reflect on the health and illness of the soul, and to find the peculiar virtue of each man in the health of his soul. In one person, of course, this health could look like its opposite in another person. —Friedrich Nietzsche, The Gay Science (1882) We step into the reception area of the treatment center, completely bathed in sunlight pouring from the windows. Every smudge on the door and windowpanes glows yellow. The linoleum floor looks as if it’s illuminated from within. Cedric rests against the receptionist’s desk, propping himself up on three fingers, his other hand clutching a satchel and several plastic bags filled with shoes, what looks like classroom handouts, and toiletries. “Makes you sleepy,” he says. We wait together in the foyer as the social worker and Cedric ’s mother talk about meeting schedules, exchange documents, and sign 4 Introduction last-minute paperwork in hushed but serious tones. Cedric is right; the warm light does make you sleepy. It is too comfortable to pay much attention to the final administrative details being negotiated only a few feet away. Cedric and I stand next to one another, silently, each with our eyes half closed . . . A white van pulls up along the sidewalk at the bottom of the stairs several feet below the front entrance. A group of young men and women returning from a day-trip marches past us, together with a rush of cool air and the smell of decaying leaves. “Will it be nice not having to do this kind of thing anymore?” I ask, referring to the group that is now heading up the stairwell to a therapy session. “I don’t know,” he says, “I still gotta take my pills and shit.” Cedric, now looking defeated, tells me, “It ain’t like I’m really leaving.” The Clinic and Elsewhere Between July 2005 and May 2008, I conducted an ethnographic study of opiate -dependent adolescents in a drug rehabilitation treatment center in Baltimore , Maryland.1 There, I followed a small group of young men and women from the time they entered residential drug treatment. Once they were discharged , I continued to follow them into their neighborhoods, homes, and other clinical and nonclinical institutional settings—including, too often, back into drug rehabilitation. The backgrounds of the adolescents I followed varied widely, not only in terms of their economic situations or demographic characteristics, but also in the ways they came to use and abuse opiates, and the paths that eventually led them into treatment. Despite the variation there was an area of experience shared among them, a common element among the therapies they received. They each had either been enrolled in a clinical trial or were currently being treated with a relatively new drug for opiate withdrawal and replacement therapy: buprenorphine.2 What emerged in my work was a focus on this pharmacotherapy, and specifically two pharmaceuticals developed under the names Suboxone (a combination drug consisting of buprenorphine and naloxone) and Subutex (buprenorphine). Working in a similar way to methadone, Suboxone and Subutex are pharmaceuticals that mirror the neurochemical effects of drugs like heroin, but have the benefit of being more easily and safely regulated in therapeutic doses—with the idea (hope) that, over time, one can be freed from dependence upon other opi- Introduction 5 ates. By engaging in a long-term ethnographic study of treatment, inside and outside the clinic, I sought to trace out patterns of pharmaceutically mediated experience and to better understand the mutual shaping of addiction and treatment for...

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