Mantengo" in the Making of Colonial Addiction

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Mantengo Recovery and Developmental Reason: The Biopolitics of Race, Hygiene, and “Mantengo" in the Making of Colonial Addiction Timothy C. Nest Division of Social and Transcultural Psychiatry McGill University, Montreal A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Master’s of Science in Psychiatry © Timothy C Nest, 2017 Nest 2 Table of Contents Abstract…………………………………………………………..……………..…3 Acknowledgements.……………………………………………………………….4 Introduction……………………………………………….……………………….5 Toward a Historical Epistemology of Addiction…………………………12 The Pastoral and the Biopolitical…………………….….………………..16 The Present Study………………………………….……….…….………18 Chapter One…………………..…………………………………………………..23 Biopolitical Sources of Race in Medicine………………………….…….24 Race, Climate, and Cosmos in French Naval Hygiene.…………………..36 Chapter Two………………………………………. ....…………………………..51 The Vital and the Ontological……………..….……………………..……... Compiling “Race”………………………..….……………………………59 Tracing Addiction: an American Disease…..……………………..………74 Chapter Three………………………………………………………….………….93 Illegibility, Mestizaje and the Wild Man ………..……………….….……94 Epidemics and Imperial Power……………………………………..……..99 The Epistemic Refinement of a Criminal Class…………………….……105 Illicit Economies and Everyday Resistance ………………….…………..107 Chapter Four……………………………………………………………………....113 The Sick Society…………..….…………………….…………………..…114 Nest 3 Biology and Central Planning……………………..…..………..…………120 An Exception of an Exception…..…………………………..…………….123 Chapter Five ………………………………………………………………………134 Epistemic Sources of Addiction…………………………………………...135 Administering Addiction Treatment…..………………………………...…144 Legacies of CISLA …..………………………………………………….…148 Conclusion………………………………………………………………………….151 “Mantengo” and the Moral Economy of Addiction………………………..153 Between “loss” and “affectability” ………………………………………...156 A New Security Paradigm……………………………………………….…160 The biopolitics of race in addiction………………………………………...165 References……………………………………………………………………….…167 Nest 4 Abstract In the first decades of the 20th century, while the Rockefeller Bureau of Social Hygiene and US Public Health Service worked diligently to establish addiction as a legitimate scientific concept in the wake of newly instated narcotics controls, Puerto Rico was in the midst of a tumultuous series of economic, social, and sanitary reforms imposed in great part through related Rockefeller institutions. Still, it would be nearly 50 years before dangerous narcotic drugs were an object of significant popular or scientific attention there. The present study traces the development of addiction services in Puerto Rico and the uneasy (colonial) import of a stable and institutionally functional concept of addiction. Rather than being a clear-cut medical response to a burgeoning public health problem, a range of institutional bodies, federal and insular, played a role in generating a singularly Puerto Rican addiction concept and an associated addiction treatment industry. This work attempts to locate a concept of addiction and addicted-persons that is not simply reducible to associated American scientific and social concepts, but was erected around long-standing local notions of delinquency, hygiene, development economics, and colonial identity detailed in the medical and popular literatures of an occupied Puerto Rico. Such a concept has persisted in shaping the manner in which Puerto Rican addicts are managed distinctly from parallel American institutions, and has also had considerable impact on practices associated with addiction recovery exercised on Latinx communities within the US, and across the globe. Nest 5 Acknowledgements I would like to thank, in no particular order: Brian Murphy, Dimitri Mugianis, Lourdes Torres Baez, Sugeily Rivera Suazo, Carmen Albizu-Garcia, Jerome Jaffe, Efren Ramírez, Salvador Santiago, Miledys Sanchez Betancourt, Julia Delgado, Eugene Raikhel, Danielle Groleau, Allan Young, Helena Hansen, Jim Baumohl, Carmen Santos-Corrada, Fernando Pico, David Dietch, Eli Oda Sheiner, Laurence Kirmayer, Eileen Findlay, David Arnold, Warwick Anderson, Ann Laura Stoler, Timothy D. Walker, Faith Wallis. This thesis is dedicated to the memory of Fernando Pico. Nest 6 Introduction In a 2016 exposé of abuses and torture of mentally ill inmates in the Florida prison system, Eyal Press observes that by the 1990’s, prisons had come to serve as “America’s dominant mental health institutions.” By now Press’ claim is all but cliche-- echoing a rich burgeoning literature on transinstitutionalization and the increasingly salient hegemony of “carceral capitalism” (Wang, 2017) in contemporary abolitionist writing. Despite these emergents trajectories in political thought, however, relatively little attention has been given to the penal dimension of what is certainly the most enduring of American psychological illness categories: addiction. Since the turn of the 20th century--first in the imperial periphery of the Philippines, and subsequently in US urban enclaves--the “moral plague” of narcotics addiction has filled an important niche in the American, and global, social imaginary; yet the link it fleshes out between penology and public health, social illness and social danger, is by no means an American invention. In its earliest instantiations, America’s medical discourses on addiction qua chronic mental disorder assumed salient features of contemporary and 19th century discourses on colonial medicine and race-thinking, fashioned and refashioned through imperial engagements following the nation’s first expeditionary war. The present thesis follows this development in two movements. In the first section, I build on archival research to deconstruct the epistemic category of addiction as a historical Nest 7 outgrowth of late 19th and early 20th century race-thinking. This work aims to resituate the debate around contemporary US drug war—a political endeavor so evocative of older forms of American social violence and so racially disproportionate that the American Civil Liberties Union has called it “the new Jim Crow.” This convergence of race and symbolic violence is no coincidence, but has roots in the very earliest constructions of addiction as an object of study, which was enacted then, as now, on disproportionately racialized and colonized populations. In the second section, I focus my attention on the present day drug war in Puerto Rico, and the more recent history of addiction treatment services negotiated in the 1960’s between the island and what is arguably the most important of its diasporic nodes, New York City. This second segment is based likewise on archival research, interviewing, participant observation, and is presented in the form of institutional ethnography--albeit a someone incomplete one. The reason I take Puerto Rico as an area of particular interest is not merely that it has been home to one of the most extreme examples of symbolic violence surrounding drug use, treatment, and criminalization. It is also the historical home of treatment paradigms that have had an indispensable influence on the way states administer drug treatment--both formally and informally-- in the present day. Still it is worthy of note that the US drug war in Puerto Rico has brought with it internationally exceptional degrees of violence (Boyd, 2001; see also Alexander, 2012). Among its most salient features, the 100-mile island today plays host to a murder rate proportionally higher than that of almost any country in the western hemisphere— including Mexico, Brazil, and the Dominican Republic—and more than 5-times that of the US. Dwarfing the near 50% figure of the broader United States, Puerto Rico’s carceral system boasts levels of Nest 8 drug-related imprisonment nearing 90% (Upegui-Hernández & Torruella, 2015; Beruff & Cordero, 2001). In addition to its burden on Puerto Rico’s prison system, drug use has had a major toll in recent decades on the island’s public health. Despite the steady decline of HIV transmission and HIV-related mortality on the US mainland over the past three decades (Center for Disease nd Control and Prevention [CDC], 2008), HIV in Puerto Rico more than doubled from 2 ​ among ​ US states and territories in 2006 (CDC, 2009), to more than 4 times the national rate in 2012 (CDC, 2012). These figures are particularly striking when taken in conjunction with an overwhelming 49% decrease in HIV transmission amongst Caribbean populations in general, which persist in yielding the highest global incidence of HIV infection and HIV-related death outside of sub-Saharan Africa (Figueroa, 2014). Contrary to the epidemiological trend of HIV transmission by way of sexual contact in the majority of Caribbean islands and the world, roughly 60% of HIV transmission in Puerto Rico is the result of drug injection (CDC, 2010). In the face of such grim realities, addicts in Puerto Rico face exceptionally severe barriers to treatment. Though “health” figures at the head of a list of economic priorities defined by the Estado Libre Asociado (Free Associated State [ELA]) government amidst growing austerity ​ constraints on the state, addiction has been notably excluded from these priorities in ways both formal and informal. Following early 1990’s legislation, which separated the funding of DESCA—the Department of Health body then responsible for managing addiction—from the broader funding of Puerto Rico’s health department, Puerto Rico’s 2000 “Mental Health Law,” explicitly eliminated substance dependence by legal definition from
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