Skip to main content
University of California Press

About the Book

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.

About the Author

Angela Garcia is Associate Professor of Anthropology at Stanford University.

Table of Contents

List of Illustrations
Acknowledgments

Introduction: American Pastoral

1. Graveyard
2. The Elegiac Addict
3. Blood Relative
4. Suicide as a Form of Life
5. Experiments with Care

Conclusion: A New Season

Notes
Bibliography
Index

Reviews

"Angela Garcia provides a painful, multilayered ethnographic portrait of the people who inhabit the valley villages, and their struggles with endemic heroin use. Like other recent works that examine the interpénétration of illicit drugs with the lives of particular places, Garcia's book is both an exploration of local culture, geography and history, as well as a deeply personal narrative journey. . . . A perceptive, compelling piece of work."
Social Forces
“Stunningly written and deeply intelligent. This is anthropology at its best.”
American Anthropologist
“A new and refreshing study. . . . This is a powerful testament, and Garcia presents a vision of where we need to go when it comes to preventing the slow suicide of addictions.”
The Progressive
“Speaks volumes about the failure of US drug policy, while at the same time making a powerful case for the dangers posed by drugs.”
Drugs and Alcohol Today
“A brutal description of drug addiction in the Española Valley and why it exists, and the terrible toll that it takes on those communities.”
New Mexico Magazine
"Timely, disturbing, and luminously written, The Pastoral Clinic is anthropology at its best, bringing into view a devastating piece of reality, highlighting larger processes and human singularities, and calling for a new public and ethics of care."—João Biehl, author of Vita: Life in a Zone of Social Abandonment

"Garcia calls for a new ethics of care for heroin addicts, exposing the insufficiency and lack of continuity of rapidly privatizing faith-based services for the rural poor. Her heartfelt ethnography of the geography of addiction in New Mexico reveals how formerly agricultural communities and families find themselves painfully embedded in a land of dispossession and displacement with an unresolvable past, and an unlivable present."—Philippe Bourgois, author of Righteous Dopefiend

"Angela Garcia has expanded the roots and basis of addictions to the great losses—personal, cultural, economic, of birthright and land—that few would dare to explore. I've sought a book like this for years, addressing my own addictions and those of the young men and women I've worked with for decades. A formidable thinker, a wrench-in-the-works activist inside and out of the industry, Angela understands that addictions are not a 'always has been and always will be' fate, but a collective, individual, and even 'intimate,' funneling into the web. And how the path toward healing, reconciliation, and wholeness is in the land, in the hand, and the capable heart of every addict and broken community."—Luis J. Rodriguez, author of Always Running: La Vida Loca, Gang Days in LA

Awards

  • Exceptional First Book Award 2010, PEN Center USA
  • Victor Turner Prize in Ethnographic Writing 2012, Society for Humanistic Anthropology