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Both victims and perpetrators.

Addicted. Pregnant. Poor.

By Kelly Ray Knight

Durham, NC: Duke University Press, 2015, 296 pp., $25.95, paperback

In 2014, Tennessee became the first state in the country to pass a law that allows women to be charged with aggravated assault--and jailed for up to fifteen years--for using drugs while pregnant. According to the Nation, at least nine Tennessee women were arrested under the law in the first months after it went into effect. One of the women committed suicide after a county sheriff hauled her off for giving birth to a baby boy with opioids in his system.

I say that Tennessee's law is the "first," because I have no reason to believe it will be the only one. In Texas, as I reported for RH Reality Check ( in 2014, some prosecutors are already attempting to jail pregnant women who use drugs, charging them with child endangerment, despite the fact that state law--shored up not just by an opinion from the state Supreme Court but from then-attorney general, now-Governor Greg Abbott--specifically exempts pregnant people from prosecution for potential harm to their fetuses.

It is into this increasingly surveilled and criminalized pregnancy landscape that University of California San Francisco anthropologist Kelly Ray Knight wades with her new ethnography, Addicted. Pregnant. Poor. It is an intimate and sometimes discomfiting look at the lives of women living in San Francisco's Mission District, denizens of a few not-yet-gentrified blocks occupied by the daily-rent hotels they sometimes call home and sometimes, when engaging in sex work, places of business.

Knight, who situates herself as anthropologist but also "outreach worker, confidant, friend, chauffeur and sometime 'doctor,'" spent four years interviewing and following women navigating the intersecting and overlapping temporal and physical challenges of addiction, pregnancy, and poverty. The nineteen women we meet in Knight's book experienced 23 pregnancies during Knight's research period, interacting with a sometimes mystifying and often complicated tapestry of social service providers, law enforcement entities, and medical professionals, along with tricks, boyfriends, husbands, children, and extended family members.

We know these women by pseudonyms--Lexi, Cupcake, Ramona, May, and many others--but Knight brings us parts of their stories in their own words, told through vignetted field notes transcribed from recorded interviews, interspersed with theory and analysis. Knight warns the reader up front not to expect any solutions to the multifaceted, coexisting problems the women who live in San Francisco's daily-rent hotels face: "What interests me," she writes, "is the problem presented by holding all these truths, not the naming of only one of them."

With the vignettes as navigational aids, Knight guides her readers through six chapters, beginning with a not-so-gentle introduction to the harsh economies of consumption (of food, of drugs, of bodies) and insecurity (of housing, of money, of drugs, of food), onto which she layers the constraints of "addicted pregnancy and time."

Knight delves into the "madness" of what she describes, in the title of chapter three, as "neurocratic futures and the disability economy," wherein we meet the "neurocrats," born of the neoliberal social policies of the 1990s, who straddle the line between advocacy and bureaucracy. In chapter four, Knight reveals the often clever and necessary ways the women navigate "street psychiatrics and new configurations of madness," as they accept or deny mental health diagnoses situationally, in order to secure housing and health care--or, as they sometimes choose, to avoid them.

She then turns to the specific realities and logistics of addicted pregnancy in poverty, from the politics of sterilization, abortion, and parenting--"stratified reproduction and the kin of last resort"--before, in the sixth chapter, examining addicted women's dualized and popularly construed role as "victim-perpetrators": the women are victims of traumatic pasts and even of their own brain chemistries, until they become pregnant, when they are perpetrators doing harm to their babies through substance use.

Throughout the book, Knight takes nothing about her presence, or the consequences of her presence, for granted and openly grapples with the role of anthropologist and ethnographer as "vulture." Medical anthropologists do not, for the most part, study the healthy pregnancies of middleclass white women. Knight's mere presence in this community, she writes in her conclusion, "reflect[s] the 'public secret' of inevitably poor outcomes."

Reading Addicted. Pregnant. Poor, is stressful, not because the reader can expect the drama of a clear resolution to the women's troubles, but precisely because she cannot. Knight's attention to multifaceted truths, to conflict, and to incongruous realities shines in her outright refusal to engage in simplification and reduction.

The closest Knight comes to assigning blame for any of the community's complicated problems and exasperating, even infuriating, circumstances, comes in her detailed history of the neoliberal "welfare reform" policies that have prompted clinicians, social service providers and, eventually, "neurocrats," to separate addiction from mental health diagnoses, in order to obtain public funding for health care and housing.

Knight brilliantly situates addicted, pregnant, poor women as inhabitants of "multiple temporalities," in a move to "unseat the temptation toward binary categorization and forward the conversation." There's addict time ("the hourly repetitious cycle of 'seeking and scoring' behaviors"); hotel time (literally 10 a.m., when the women would have to find the day's rent, and every three weeks, when they can be ousted by hotel owners to avoid tenancy law conflicts); and pregnancy time (nine months, fraught with questions such as, "How much time can I keep using [drugs] before I have to stop?"). There's jail time and treatment time, dictated by institutions, as well as epidemiological time--many of the women participate in studies that organize them into discrete categories, based on frequency of drug use--and biomedical time, the measures by which legal, medical, clinical entities shuffle and classify their cases. Finally, there is memorial time, as the trauma of past violence bleeds into the present, affecting the women's experience and perhaps even the length of their lifetimes.

(It's worth noting that trans men and genderqueer people may also experience the temporal and logistical strains within the triad of addiction, poverty, and pregnancy. Knight's book is concerned with cisgender women.)

Broadly, Knight asks her reader to do what so many narratives about addiction, poverty, and pregnancy do not: withhold judgment, withhold decision making, withhold certainty. It is the women--pregnant, impoverished, addicted, shamed on the nighttime news as "toxic moms" who refuse to take responsibility for their lives and families--whose honest, complex voices make this possible. The book really sings when Lexi, Cupcake, Ramona, Anita, and their cohort speak, talking Knight through their fears about "sleeping rough," their dislike or affection for clinicians and social workers who get it (or don't), and perhaps most profoundly, through the heartbreak not just of pregnancy loss, but of pregnancy itself.

It is a remarkable intervention to treat addicted, poor, pregnant women as no more and no less than human beings, and Knight's vignettes work to make that option available to readers who may never before have considered the possibility. Knight's analysis of the so-called toxic mom as victim-perpetrator works especially beautifully if you're already well versed in the misogynist media rhetoric that shames and derides pregnant and addicted women; but if you stick with the book, you will probably go along with Knight's analysis even if you weren't well versed before.

Yet, while Knight effectively demolishes the "crack baby" myth, for example, her evidence that it necessarily translates, within the national media landscape itself, into a narrative about the mothers may seem thin to readers new to her subject. The book isn't meant to be media analysis, though; it is ethnography, and it loses no resonance because of this.

Knight is largely silent on the role that race plays in the "multiple temporalities" of the women she worked with during the four years of her research, though they themselves occasionally talk of the particular challenges that race presents. Lexi, for example, expresses frustration with the difficulty of picking up sex work because she is black, telling Knight that clients prefer women with white skin. But Knight offers no explicit racial analysis beyond observing, in her treatment of neoliberal welfare policies and the research thereon, the disproportionate damage those policies perpetrate on people of color.

If this omission--and it does feel like an omission--is deliberate, Knight does not address it in any detail, though she writes that she is well aware of her positionality as a middle-class white woman with the privilege of, as she describes it, going home every night to her family, perhaps to read Harry Potter to her daughter. It's possible that the relative colorblindness of the text, otherwise occasionally heady with anthropological theorization on gender, ability, and class, is an intentional move away from the stigmatization and stereotype that usually arise in conversations about sex workers of color. However, if so, it requires an explanation that we never receive.

While the book is basically accessible to the general reader, some of Knight's weedy extrapolations from her fieldwork may occasionally frustrate some, as they find themselves trying to remember their freshman-year Foucault, or if they never had the opportunity to study him in the first place. "Biopolitics" and "necropolitics"--very broadly, the social and political forces behind life and living, and death and dying, respectively--play significant roles in Knight's analysis--especially in her situation of the Mission District women as "multibeings," whose agency and positionality change as they are churned through a system that produces and reproduces bodily and institutional order and disorder within and among individuals.

Blessedly, Knight's footnotes are both thorough and edifying, often as engaging as the text itself. The reader who wants more on the history of neoliberalism and the social safety net will find it in the back of the book; they will also find analyses of America's ecopolitical histories (think Wall Street versus Main Street) laid out with clarity.

Ultimately, Knight refuses to let the women in Addicted. Pregnant. Poor, be reduced or caricatured through facile arguments about morality and motherhood. Instead, she asks a deceptively simple question about the layers of their lives, stacked like the multistory hotels they inhabit: "What forms of life are possible here?" It's a question we'll do well to ask ourselves in the coming months and years, as lawmakers, now apparently locked into a neoliberal narrative of America that eschews the strengthening of the safety net, move toward increasing penalties and prosecutions for drug use during pregnancy.

Andrea Grimes is the digital editor at the Texas Observer. Her work has also appeared in Rolling Stone, Ms. and RH Reality Check. She holds a master's degree in cultural anthropology from the University of Texas, and lives in Austin with her husband, two cats, and a badly behaved hound dog.
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Title Annotation:Addicted. Pregnant. Poor
Author:Grimes, Andrea
Publication:The Women's Review of Books
Article Type:Book review
Date:Mar 1, 2016
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