The Clinic and Elsewhere: Addiction, Adolescents, and the Afterlife of Therapy

2 / Monasticism

36 2 / Monasticism Phenomenology demands that images be lived directly, that they be taken as events in life. When the image is new, the world is new. —Gaston Bachelard, The Poetics of Space A long a hallway wall of the treatment center hangs a small picture of Christ leading a group of his followers along a rocky path. The print is yellowed and its placement on the wall inconspicuous. Each time I would pass the image I wondered if it had been intentionally left hanging because in some way it was representative of the treatment process, or whether it had simply been overlooked. I wondered if this was the scene of recovery or merely an artifact of the former incarnation of the place. Through close attention to three young men and one young woman, in the following chapter I want to offer a picture of what it is to negotiate transactions between body and space in residential drug-dependency treatment. In doing so, I wish to reflect upon the conditions that come to form an image of adolescents under treatment. If, as Bachelard suggests, the world is made anew through the image, then how one goes about rendering such an image is crucial. Clinic and Monastery The residential drug treatment center is an old converted monastery— though “converted” may be an overstatement.1 Religious imagery can still be found scattered on the walls and represented in statues that cover the grounds. The monastery was originally built in the Irvington neighborhood located in southwest Baltimore in 1868, and, after a fire, rebuilt in 1886. The parish church attached to the old monastery was built in 1932, and remains operational today. Monasticism 37 To say that the setting feels monastic conveys a sense that is only too obvious. The building is enormous. The halls echo loudly and were clearly designed for a quieter clientele. Large windows cover the back wall of the four-story stairwell, affording a view of what used to be herb and vegetable gardens. The front windows afford an expansive vista onto one of the oldest Catholic cemeteries in the city. The section of the cemetery seen from the top floor contains the graves of hundreds of fallen confederate soldiers. The clinical and administrative offices occupy old cells meant originally for prayer and meditation. The building is austere. I was never once unaware of its former incarnation. Even the old bingo hall was host to nightly outpatient therapy. But “monasticism” in the treatment center is not only a characterization of its physical features. The adolescents who take up residence in this place are charged with following routines, led through everyday rituals of eating, working, sleeping—their bodies and minds being trained through recitation in group therapy and individual counseling, in service of recovery and rebirth.2 The center is secluded, an island in the city. Here, adolescents are meant to establish new forms of behavior, new patterns of being, new performances of the everyday, new bodily and mental habits. Such things are inescapable if one wants to succeed in treatment. Disguising Details The treatment center opened in 1989 as part of an established system of behavioral healthcare programs for adults and adolescents in Maryland. The center primarily serves inner-city Baltimore, although referrals from public-sector agencies (juvenile justice and social services) outside the city were also common. At the center, three basic forms of service are provided: short-term residential treatment, day treatment (partial hospitalization), and intensive outpatient care. The adolescents who populate the treatment center have a high severity of substance abuse and most have had unsuccessful periods of treatment in the past. Many of the adolescents have emotional and behavioral symptoms, comorbid psychiatric disorders, and significant functional impairments.3 Roughly sixty-five adolescents stay at the center on any given day, and of these, approximately two-thirds are male and one-third female, ranging in 38 Chapter 2 age from 11 to 20. Despite the wide age range in the treatment center population , my focus was on 14 to 18 year olds. I was interested in adolescents who were poised at several crossroads—who were at a moment marked by clinical , social, and developmental transitions, and for whom significant changes were occurring in the trajectory of drug use.4 Table 1. Diagnostic and Statistical Manual of Mental Disorders—IV: Criteria for Dependency and Abuse. Monasticism 39 The ethnic composition of the treatment center is roughly one-third African American and two-thirds Caucasian. The primary funding...