Addicted. Pregnant. Poor by Kelly Ray Knight (Duke University Press, 2015).
This deeply engaging and long standing ethnography conducted from 2007 to 2011 fully discloses the sufferings of women living in daily rent hotels in abandoned industrial spaces in San Francisco, who are categorised as “addicted, pregnant, poor.” Kelly Ray Knight focuses on the pregnancy-related issues of addicted women — from maternal & foetal health to legal custody — that are often ‘hidden in plain sight.’ In contrast to the high-tech neighbourhood of Silicon Valley in San Francisco, the urban ghettos in which the case study explores is home to chronically homeless men and women who are part of the drug-sex economy. In the United States, the rate of illicit drug use amongst pregnant women leading to drug-addicted babies increased in the late 2000s, which led to extra attention to the issues of addicted, pregnant and poor.
Knight’s interest in the topic was raised by chance while repeatedly witnessing addicted and pregnant women in insanitary hotels. Knight, having engaged in public health work with women with drug addictions in San Francisco for over fifteen years, also felt agony or even indignation when witnessing pregnant women smoking crack, even confessing that sometimes she thought ‘I just want to kill her’ (p. 231). During her fieldwork, she intended to keep her self-reflective ethical stance away from her work, since the relationships she engaged with made her feel ‘vulturistic, indebted, intimate, paternalistic, helpless, judgmental, empathetic and confused’ (p. 28). Consequently, through writing herself in to the ethnography, without ‘presenting an omniscient narrative” and “depoliticising the anthropologist’s presence,’ she successfully delivers her emotional interactions with the women (p. 219).
Her research centred on the hotels that are rented by women per day, which facilitated her access to the drug-sex economies and temporary housing, also increasing the visibility of the everyday violence these women experienced. Particularly, she emphasises the competing constraints of temporality on the lives of homeless and addicted people, such as “addict time” (as hourly seeking and scoring drugs), and “hotel time” (as paying $35-60 per day for a room, which often led to more sex work in the hotel). These competing schedules of ‘time’ pushed the women into living in a vicious cycle. Conception often arose under those conditions and the pregnant women — homeless and addicted — was perceived as nine month ‘biomedical time bombs’ from an institutional perspective (p. 77). While some women did not care about the dangers of continuous drug use during their pregnancy, Knight discovered that some embraced pregnancy as ‘a wake-up call’ provide the opportunity of receiving drug replacement therapy programs (e.g. methadone treatment for opiate dependency) of which records would be an evidence to request the child custody later from Child Protective Services (p. 78 and 83).
What is impressive is how the author effectively reveals the pregnant addicts’ brutal reality through coining new concepts such as ‘neurocrats’, ‘street psychiatrics,’ ‘victim-perpetrator,’ and ‘anthro-vulturing.’ Firstly, in Chapter three, Knight defines ‘neurocrat’ as the person who collects diverse documentation to distinguish mental illness (PTSD, bipolar disorder) from addiction in order for the women to claim federal disability benefits. Given that addicted women become socially abandoned — the so-called ‘dead alive,’ or ‘ex-human’ (cf. Biehl 2005) — being officially classed as mentally-ill is a realistic tactic to secure support from the mental health system. In Chapter four, Knight describes their ordinary self-diagnosis and self-medication with stimulants, opiates/opioids and other substances (“street psychiatric practices“). Her approach was original enough to challenge the biomedical and psychological boundaries of the definition of addiction. She translated the women’s drug abuse as self-prescription so as to keep themselves ‘productive’ on the street and in the daily rent hotels. Her engaged fieldwork allowed her to provide convincing evidence: ‘Speed’ (methamphetamine) for being peaceful and sociable and ‘Crack’ (cocaine) for feeling angry and remaining tough (p. 129).
Knight explores contemporary eugenics as ‘stratified reproduction’ (Collen 1995) in Chapter Five, through registering women’s anecdotes of sterilization procedures. She underscores that the United States has plentiful examples of ‘State-funded efforts’ to enforce sterilisation on women, particularly poor African-American women (p. 153). She also draws attention to the fact that the disempowerment of addicted women’s nurturing and reproduction is based on the scientific explanation for addiction; it is a heritable brain disease and mental illness; therefore, the psychotic, addictive and negative personality traits of pregnant addicts would be passed onto their children (p. 165). In reality, they were highly encouraged to the ‘paid’ sterilisation (e.g. by “Project Prevention,” paying drug addicts and alcoholics $300 to use long-term birth control) (p.201), and sometimes ‘forced’ sterilisation (e.g. tube ligation or hysterectomy enforced by doctors warning poor health outcomes of babies of ‘toxic mom’) (p.171 and 172). Furthermore, Knight grasped the ambivalence of the objectivity of science; it can be a redemptive narrative to liberating addicted women from guilt and shame but also requires a loss of autonomy to control their life choices.
Overall, the distinct value of this ethnography comes from the author’s deepest reflection on her paradoxical position as both ‘vulturing anthropologist’ and outreach worker, confidant and friend. Concurrently, she points out the ambivalent realities of pregnant addicts in Chapter Six: a victim living in a risky society and a perpetrator who intentionally gets arrested to gain access to care and treatment. This thorough analysis, although unique and undoubtedly worthwhile as a result of the anthropologist’s vantage point, occasionally highlights not only her worrisome tension between an interventionist’s perspective and witness’s stance, but also the limitations of anthropological evidence. While she, as an outreaching worker for over fifteen years, felt skeptical of the efficiency of offering interventions, she appreciates her critically engaging anthropological work as a ‘unique lens’ showing the complexity of addicted pregnancy.
The author’s thoroughness with respect to describing personal feelings, however, is rather an obstacle to the further critical discussion on her work; that is, whether the limitations she mentions in her work result from limitation of a current society or an anthropological research or herself. For me, although she felt embarrassed or even upset when bearing witness to pregnant women smoking crack, it was unclear whether she asked how they actually felt when smoking crack in front of her. She seems to fail to listen to the addicted woman’s body language (e.g. answering ‘with a sheepish grin’) rather only hearing the spoken word when she was told “Smoke crack” by an addicted woman have just lost her daughter’s custody due to her addiction (p. 238); that is, failing to doubt why the woman showed a sheepish grin to her. Notwithstanding a complicated tension between her perspectives as an anthropologist, public health worker and a mother with two children, this fully engaging in-depth ethnography provides a compelling story of critically inclusive and self-reflexive understandings of addicted, pregnant, and poor women in the urban area.
Reviewed by Kwanwook Kim, PhD candidate in Anthropology department at Durham University. He is researching on the phenomenology of Korean female call centre workers and health in terms of emotional labour, lived experience of humiliation, embodiment of class and gender role, and working drugs (e.g. smoking). He is a family medicine doctor in Korea, involved in smoking cessation clinics and researched smoking behaviour of working-class and female, particularly with respect to health inequality.
Correspondence to Dr Kwanwook Kim.
Biehl, João. 2005. Vita: Life in a zone of social abandonment. University of California Press.
Colen, Shellee. 1995. “Like a Mother to Them”: Stratified Reproduction and West Indian Childcare Workers and Employers in New York. Ginsburg, F. D., and Rayna Rapp (eds), Conceiving the new world order: The global politics of reproduction. University of California Press, pp.78-102.