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The Pastoral Clinic: Addiction and Dispossession along the Rio Grande
The Pastoral Clinic takes us on a penetrating journey into an iconic Western landscape—northern New Mexico’s Española Valley, home to the highest rate of heroin addiction and fatal overdoses in the United States. In a luminous narrative, Angela Garcia chronicles the lives of several Hispanic addicts, introducing us to the intimate, physical, and institutional dependencies in which they are entangled. We discover how history pervades this region that has endured centuries of social inequality, drug and alcohol abuse, and material and cultural dispossession, and we come to see its experience of the opioid epidemic as a contemporary expression of these conditions, as well as a manifestation of the human desire to be released from them. With lyrical prose, evoking the Española Valley and its residents through conversations, encounters, and recollections, The Pastoral Clinic is at once a devastating portrait of immigration and addiction, a rich ethnography of place, and an eloquent call to political activists, politicians, and medical professionals for a new ethics of substance abuse treatment and care.
264 pages, Paperback
First published June 8, 2010
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Displaying 1 - 30 of 57 reviews
December 22, 2014
Angela Garcia was (is) my professor, and I read this book for her class at Stanford on the Anthropology of Drugs. Garcia has one of the most nuanced and informed views on drug use (particularly addiction in a Mexican/Chicano/Native American setting) I have ever seen. Her class opened up my eyes to a lot of aspects of (American) drug culture that I had previously overlooked.
This book could very easily have been extremely boring and hard to read. Rather, it was a pretty quick read for me, and enjoyable the whole way through. At times, the anthropological analysis could be hard for someone with no background in the field, but it is framed by personal narratives of the people she worked with that would be illuminating and poignant to anyone.
Before reading the book I was told by an Anthro-major friend of mine that other professors of hers had called the introduction to the book "one of the best pieces of Anthropological analysis ever written". I may have a limited background in the field, but I can see why this is the case.
This book could very easily have been extremely boring and hard to read. Rather, it was a pretty quick read for me, and enjoyable the whole way through. At times, the anthropological analysis could be hard for someone with no background in the field, but it is framed by personal narratives of the people she worked with that would be illuminating and poignant to anyone.
Before reading the book I was told by an Anthro-major friend of mine that other professors of hers had called the introduction to the book "one of the best pieces of Anthropological analysis ever written". I may have a limited background in the field, but I can see why this is the case.
February 18, 2020
Possibly one of the best ethnographies I've ever read? Is that too much praise? I think not. In terms of academic books Garcia does a good job of balancing theory vs. stories. A good ethnography proves it's point by showing not by telling you through obtuse, theoretical, academic language. Garcia undoubtedly shows us the impact of colonialism.
I simply cannot overstate how heavy and important the subject matter of this book is. We are a colonial society and to think that period of history is over and done with is bullshit. It's alive and well here in 2020, and as told in The Pastoral Clinic it is DEEPLY entwined with heroin addiction in New Mexico.
I simply cannot overstate how heavy and important the subject matter of this book is. We are a colonial society and to think that period of history is over and done with is bullshit. It's alive and well here in 2020, and as told in The Pastoral Clinic it is DEEPLY entwined with heroin addiction in New Mexico.
June 24, 2013
Read The Pastoral Clinic for a psychological anthropology class at UCLA. Garcia chronicles heroin addiction in the Espanola Valley through a thoughtful, well-constructed ethnography that explores the historical, regional, personal processes at play. The writing is self-aware and accessible and the information and perspectives are illuminating.
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June 29, 2024This really resonated with me. While it's obviously foundational to understanding addiction the biocentric "disease" model is far from complete and this does a good job exploring the broader cultural context of addiction within one particular example. There's something of a necessary overcorrection here - replace culturally specific "ways of knowing" with "ways of using", maybe, and the same issues remain. I was totally unaware of New Mexico's unique history and I enjoyed how it weaved these troubled legacies into this very modern issue - it's hard to imagine that the research this was based on was conducted in 2005, and frightening to imagine that things are probably far worse today. Tragic, shocking, and yet just a little bit hopeful.
December 5, 2016
"While it may be true that she and even I cannot conceive of a plan of care that could incorporate all the history, all the losses, this is precisely what families try to do for one another every day. They conceive of ways to care for one another in a context where their very relations, and the very struggle to maintain the everyday, are at stake. Of course, they often fail, and tragically so. But they keep trying to the very end."
July 19, 2019
Her research reads like a story. The writing is very well done. Although, getting through the ethnography can be difficult at times because the subject matter is disheartening. There's an imminent feeling of hopelessness that arises from examining the complex web of personal, social, cultural, institutional and environmental strands that work together to characterize the community's relationship with heroin. Nonetheless, I think the book does a great job of humanizing addiction and unveiling the issues of approaching addiction from a purely medical standpoint.
April 26, 2023
This ethnography changed the game for a reason -- homecoming anthropology at its finest.
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November 11, 2024letting myself log this because i didn’t technically read it for class
November 10, 2023
this ethnography was so incredibly engaging and well-written i think i'm gonna read it again. this was one of 3 assigned books for dr hollan's psych anthro class at ucla and what is most shocking to me is that this was written so long ago. its research like this that keeps me motivated to continue school. but since this was written how has the views on addiction changed? has programming changed or improved? i hadnt thought about drug use in the way that garcia illustrated it throughout her ethnography. i don't know much about new mexico or much on drug-use but i know that it is a common tragedy in most major cities??? idk this review is all over the place! time to write my essay!
December 17, 2023
Best book I ever read for class ngl, Angela Garcia is a really talented writer, but the ethical dilemmas she creates are oh boy...
December 11, 2024
Tragically still revelant and extremely important for policy makers and the public who care about the opioid epidemic, this book is full of sadness and despair. I read and wrote a précis on this book for my Cultural Anthropology class. There's a lot to unpack here; García's writing is really dense, and any summary or review is going to miss crucial points. I include excerpts from my book report:
Dr. Angela García’s long introduction to her research between 2004 and 2006 first sets the scene in Española Valley and the Nuevo Día treatment center, with herself and three of the subjects of the book. With “Este río está muerto [This river is dead],” (p. 3) John said, followed by his abrupt departure from the clinic, she sets up a repeated theme throughout the book of the death of the land being tied to the death of the people, and a sense of pointlessness of the treatment program. She focuses heavily on a number of themes: first, “chronicity”, or the sense of the chronic or never-ending cycle of addiction →clinic→prison. Second, the juxtaposition of social and family ties with the “singularity” - the shared aloneness - of addiction and the pain of withdrawal. Finally the “pastoral” conceptualization of care, combining the history and landscape of rural New Mexico with the ideas of a shepherd tending his flock or a pastor caring for his/her congregants, suggesting that a better model than the current, is one that is personal and integrative. This pastoral framework requires a deeper knowledge of those treated, their backgrounds, familial and regional histories, religion, public health concerns, and “the legal apparatus.” as she puts it, that orders such “care.” She finally expresses the desired outcome that, based on her analysis, “success” not only could become more common, but that the definitions of “success” and “failure” will necessarily become more nuanced and fluid.
It was tough to read this having lived eight years in New Mexico, 15 months of that in Los Alamos, and the rest in Albuquerque. I had always viewed Northern New Mexico as peaceful and awe-inspiring, yet not without its troubling aspects, particularly around LANL, where nuclear weapons research is ongoing, and where I was already aware of radioactive and chemical hazards. This was a lesson in the harsh realities of the people born and raised there and the region’s history. It was also eye-opening about the inner lives and outer experiences of addicts. I had been in favor of the California “care courts,” but based on this book, I will no longer support this policy. Dr. García makes it so clear it causes more harm. My intention is to advocate against the care courts, or barring that, find a way to advocate for “harm reduction” with respect to their implementation.
Dr. García's work focused on rural New Mexican Hispano experiences and troubles with heroin addiction, but the things she witnesses and the points she makes still have broad applicability. García makes a compelling case that these systems, however well-intentioned, have not only failed those they intended to help, they have deepened and broadened the harms of addiction. They reinforce self-perceptions of failure and "chronicity", ending only upon death. These policies and standards of "care," combined with the legal apparatus used against addicts, create a conflicting view of an addict as a "patient-prisoner." By doing this, it also reinforces existing ideas about the nature of addiction. The importance of applying the understandings toward formulating effective and ethical health care policies and “juridical” systems relating to addiction cannot be overstated.
Dr. Angela García’s long introduction to her research between 2004 and 2006 first sets the scene in Española Valley and the Nuevo Día treatment center, with herself and three of the subjects of the book. With “Este río está muerto [This river is dead],” (p. 3) John said, followed by his abrupt departure from the clinic, she sets up a repeated theme throughout the book of the death of the land being tied to the death of the people, and a sense of pointlessness of the treatment program. She focuses heavily on a number of themes: first, “chronicity”, or the sense of the chronic or never-ending cycle of addiction →clinic→prison. Second, the juxtaposition of social and family ties with the “singularity” - the shared aloneness - of addiction and the pain of withdrawal. Finally the “pastoral” conceptualization of care, combining the history and landscape of rural New Mexico with the ideas of a shepherd tending his flock or a pastor caring for his/her congregants, suggesting that a better model than the current, is one that is personal and integrative. This pastoral framework requires a deeper knowledge of those treated, their backgrounds, familial and regional histories, religion, public health concerns, and “the legal apparatus.” as she puts it, that orders such “care.” She finally expresses the desired outcome that, based on her analysis, “success” not only could become more common, but that the definitions of “success” and “failure” will necessarily become more nuanced and fluid.
It was tough to read this having lived eight years in New Mexico, 15 months of that in Los Alamos, and the rest in Albuquerque. I had always viewed Northern New Mexico as peaceful and awe-inspiring, yet not without its troubling aspects, particularly around LANL, where nuclear weapons research is ongoing, and where I was already aware of radioactive and chemical hazards. This was a lesson in the harsh realities of the people born and raised there and the region’s history. It was also eye-opening about the inner lives and outer experiences of addicts. I had been in favor of the California “care courts,” but based on this book, I will no longer support this policy. Dr. García makes it so clear it causes more harm. My intention is to advocate against the care courts, or barring that, find a way to advocate for “harm reduction” with respect to their implementation.
Dr. García's work focused on rural New Mexican Hispano experiences and troubles with heroin addiction, but the things she witnesses and the points she makes still have broad applicability. García makes a compelling case that these systems, however well-intentioned, have not only failed those they intended to help, they have deepened and broadened the harms of addiction. They reinforce self-perceptions of failure and "chronicity", ending only upon death. These policies and standards of "care," combined with the legal apparatus used against addicts, create a conflicting view of an addict as a "patient-prisoner." By doing this, it also reinforces existing ideas about the nature of addiction. The importance of applying the understandings toward formulating effective and ethical health care policies and “juridical” systems relating to addiction cannot be overstated.
October 8, 2023
Fantastisk antropologisk feltstudie!!
Ángela García undersøger hendes eget "hjem" som er stærkt præget af heroin afhængighed og problemer i de institutioner der skulle hjælpe de udsatte.
Hun undersøger miljøet ved at blive en del af en klinik, som har store mangler på ansatte og erfarne. Derudover undersøger hun hvordan den negative terminologi omkring udredelse og håb også er med til at fortsætte den uendelige cirkel af afhængighed.
Hendes værk er skrevet utrolig letlæseligt og kan sagtens læses af ikke-studerende. Hun beskriver hele processen af sit arbejde gennem meta sprog og bruger eksempler fra hendes tid på klinikken meget beskriveligt og levende, så det på ingen måde bliver tørt at læse i længden og holder interessen ved at have en fin balance mellem fagligt og reportage lignende sprog.
Indledningen er et pragteksemplar på hvordan man laver antropologisk feltarbejde og hvilke overvejelser man skal gøre sig i processen for at få det bedste resultat og gøre det på en måde så de observerede ikke føler sig krænkede eller misforstået.
Kæmpe anbefaling, selvom man ikke er interesseret i emnet ellers
Ángela García undersøger hendes eget "hjem" som er stærkt præget af heroin afhængighed og problemer i de institutioner der skulle hjælpe de udsatte.
Hun undersøger miljøet ved at blive en del af en klinik, som har store mangler på ansatte og erfarne. Derudover undersøger hun hvordan den negative terminologi omkring udredelse og håb også er med til at fortsætte den uendelige cirkel af afhængighed.
Hendes værk er skrevet utrolig letlæseligt og kan sagtens læses af ikke-studerende. Hun beskriver hele processen af sit arbejde gennem meta sprog og bruger eksempler fra hendes tid på klinikken meget beskriveligt og levende, så det på ingen måde bliver tørt at læse i længden og holder interessen ved at have en fin balance mellem fagligt og reportage lignende sprog.
Indledningen er et pragteksemplar på hvordan man laver antropologisk feltarbejde og hvilke overvejelser man skal gøre sig i processen for at få det bedste resultat og gøre det på en måde så de observerede ikke føler sig krænkede eller misforstået.
Kæmpe anbefaling, selvom man ikke er interesseret i emnet ellers
November 17, 2023
A heartbreaking but incredibly relevant exploration of heroin addiction in rural New Mexico. This was one of the most interesting and insightful books I have been required to read for a college course (psycho-anthro at UCLA). Garcia’s storytelling puts the audience in the narrative, bringing to light extremely important aspects of addiction that are left out of healthcare practices. Her exploration of generational and familial drug use illuminated a completely new perspective on the cycles of addiction for me. It is rare that I feel as if a book changed my perception of the world, but Pastoral Clinic did just that in an easy to understand and hard to put down ethnography. I am very grateful to have read this book and discuss it in depth as part of my academic experience.
April 3, 2019
A stunning and courageous ethnography, written beautifully, and both intellectually and emotionally (although I would like to trouble the binary between those!) challenging. Garcia is self-reflexive in examining her own relationship to her subject-loved ones and the land (on which) she's studying, creating a sort of bodymap for a geographic area that is both visible on and constituted by the bodies of those who live on it.
April 7, 2020
read this for a seminar class. quite a heavy read but garcia writes the ethnography very uniquely - as if she was telling a story and it flows smoothly without the interruption of facts that can deter one away from the humanistic elements of ethnographic research. embedded theories were also very interesting (lots of nietzsche among others), and she is incredibly humble in her interpretations of retelling the lives of her informants
March 18, 2022
“i would add that seeing and experiencing the world and the past as painful—and to not appropriate, forget, or sublimate this pain for other purposes—is likewise a way of living in the world. in other words, there is meaning in melancholia, meaning in wounds that haven’t healed, perhaps may never heal.”
holy shit this took me forever to finish but this is genuinely one of the most incredible books i have ever read in my LIFE ?
holy shit this took me forever to finish but this is genuinely one of the most incredible books i have ever read in my LIFE ?
October 13, 2025
4.5/5. A combination of my personal interests, beautiful writing, and brilliant analysis are exactly why I could read this book so fast while also having such a heavy school course load. I especially loved the second chapter and rethinking the recovery narrative about viewing addiction as a chronic illness that you will always live with. Perhaps it might be more valuable to focus on a future with hope and love instead. Just so touching.
April 5, 2023
Read for Cultural Anthropology- Great look into heroin addiction and cycle in Española Valley in New Mexico, VERY depressing and not much hope until conclusion but the hopelessness was definitely needed for this discussion. Wish Garcia had talked a little more about her positionality in relation to the addicts she works with.
December 21, 2020
This ethnography chronicles the struggles of people addicted to heroin in New Mexico. Well based on anthropological research, this book manages to remain extremely interesting and engaging. For me, it provides insight into a life experience I had never imagined nor comprehended.
September 4, 2017
Heartbreaking.
October 15, 2017
Written like a thesis. Reads like short stories.
January 16, 2018
One of the best ethnographies I've read.
November 8, 2018
best ethnography i've read in a long time
September 30, 2019
An absolute must for every care provider in Northern New Mexico. Stunning, poignant and an honest look into colonization’s affect on a rural region.
December 3, 2020
The most well-written ethnography I have read to date. Contextualices heroin addiction as something that is deeply embedded in kinship, and the loss and dispossession of land. Biomedicine alone is simply not enough to aid in the recovery process of those battling physical affliction, and Garcia is able to show exactly that through her work.
December 8, 2020
read this for an anthropology class
very interesting, thoroughly enjoyed it :)
very interesting, thoroughly enjoyed it :)
February 21, 2021
While I did enjoy the personal profiles in here, the author's commentary feels self-indulgent. It focuses more on her and her thoughts than the actual people being discussed.
March 27, 2021
in-fucking-credible
November 1, 2021
Read for med anth. I think there is some tension in her framework about commensurability but such a beautifully written ethnography.
February 21, 2022
Maybe I thoroughly enjoy psychological anthropology
Displaying 1 - 30 of 57 reviews