Yale Psychiatry Grand Rounds: October 9, 2020

Name: Yale Psychiatry Grand Rounds: October 9, 2020
Uploaded: 2020-10-12T13:22:22.603Z
Duration: 1 h 26 min 11 s
Description: Angela Garcia, PhD, Associate Professor of Anthropology, Stanford University: RebPsych Conference: "Rethinking Addiction Recovery: Lessons from the Underground, Adversity"

October 12, 2020

Angela Garcia, PhD, Associate Professor of Anthropology, Stanford University:

RebPsych Conference: "Rethinking Addiction Recovery: Lessons from the Underground, Adversity"

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00:00And you should be able to see
00:01the directions at the top.
00:02I believe that was one of the
00:05first comments in the chat.
00:07And with that I will go ahead and
00:08turn it over to Professor Garcia.
00:10Thank you so much for coming.
00:14Thank you for the invitation to the
00:17organizing committee for inviting me.
00:19Let me just make sure.
00:22I get that, oh, that's sorry,
00:25let me see I need to just get my.
00:29My slides up. Anne.
00:34I am just about there.
00:40OK. Do you see is that everyone?
00:47It just need to change it back to that view,
00:50put it on play like you did earlier.
00:52Ah, where is play in the center?
00:56Yeah up top center.
00:58Top center sorry about this, I'm learning,
01:01as everyone else is perfect right there?
01:05OK, wonderful, thank you.
01:08So this talk is based on a 7 year
01:11anthropological research project
01:12that I'm continuing to be engaged in,
01:16and it's about Compulsory.
01:19Or coercive residential centers in
01:21Mexico for the treatment of addiction.
01:25And these coercive centers,
01:27which are unregulated and developed
01:30by and for the working poor,
01:32are widespread in Mexico and our growing
01:36throughout Latin America and in Mexico.
01:39The they are called a nexos,
01:42which means annex and or 24 hour groups.
01:46There also called Grand, has or farms.
01:50Particularly those that are
01:52located in the provinces.
01:53These, like I mentioned,
01:55are run and utilized by poor
01:58individuals and communities that lack
02:01access to professional health care,
02:03drug users and others with mental health
02:07issues are usually taken there by force,
02:10although some do voluntarily enter.
02:14In an exhaust,
02:15the patients are called annex
02:17of OS or the annexed and their
02:20confined for a period of months,
02:23two years and subjected to a mix of
02:26intervention from extended 12 step
02:28meetings to physical discipline.
02:31Typically they remain in a nexos
02:33until they are claimed by a
02:35relative or until a relative can
02:37no longer afford the monthly fee,
02:40or until they are considered
02:42successfully rehabilitated.
02:43Now,
02:43despite the lack of empirical
02:45research on and exo's,
02:47recent publications have condemned them
02:49for being unethical and ineffective.
02:52Many medical professionals,
02:53scholars and humanity,
02:55human rights organizations have
02:56called for their replacement with
02:59evidence based treatment practices,
03:01grounding their arguments in
03:03universal principles of human rights
03:06and codes of professional conduct.
03:09While these discussions have shed
03:11light on the stark disparities in the
03:14quality and availability of addiction
03:16treatment offered around the world,
03:18they have largely ignored the
03:21structures of chronic inequality
03:22that shaped the differential
03:24distribution of addiction treatment
03:26as well as the struggles of poor
03:29families who must make decisions
03:31on how to care for addicted kin.
03:35Few published accounts of poor
03:37family upside few published accounts
03:39of the violence within an excess.
03:41Which is the centerpiece of these critiques,
03:44have considered the violence
03:46that surrounds them.
03:49This talk glass I mentioned draws on
03:52my 7 year theological study of these
03:55addiction centers in an around Mexico City.
03:59It provides much needed documentation
04:01of day-to-day life in a nexos and
04:04demonstrates the significant influence of
04:07socioeconomic context on their structure,
04:10practices, and constituents.
04:11It describes the next source not as
04:15violations of a presumed universal norm,
04:17but as an articulation of the complex
04:20environment and also histories
04:22in which they are immersed.
04:24The point of my work is not to absolve the
04:27next source of their potential to harm,
04:30nor is it to evaluate their
04:32effectiveness in treating addiction.
04:33Rather, my point is to examine how
04:36the unequal distribution of violence
04:38and vulnerability in Mexico shapes.
04:41The treatment needs,
04:42methods and possibilities within a nexos.
04:45My research also argues that any attempt
04:48by health authorities or medical
04:50professionals to improve or regulate
04:52addiction treatment in a nexos must
04:54be grounded in the realities of those
04:56who suffer within an around them.
05:00So what are some of these realities in
05:042006 when President Felipe Calderon
05:07deployed the Mexican military to
05:10fight the war on drugs?
05:12270,075 thousand people have since died.
05:1674,000 people have disappeared.
05:1820% of both populations are
05:20minors under the age of 18.
05:24According to the UN,
05:26femicide is a national emergency in Mexico,
05:30which is now one of the worst
05:34rates of femicide in the world.
05:37Yet in 2020, Mexico,
05:39through planned by the new president amonal,
05:43slashed federal spending by 75% for
05:46services and shelters for women and
05:49children endangered by criminal violence.
05:5298% of all violent crimes are unresolved.
05:57So Mexican officials have consistently
06:00claimed that 90% of victims killed in the
06:04drug war an killed through famous site
06:07are criminals involved in the drug trade.
06:11Human rights organizations,
06:13civil society groups and families
06:15affected by violence insists that these
06:18are innocent victims who comprise the
06:21vast majority of the drug war victims,
06:24children,
06:24migrants,
06:25the rural and urban poor young women,
06:28undereducated and unemployed youth and
06:30people simply caught in the crossfire.
06:33The narrative of victims versus
06:36criminal is gaining traction in the
06:39eyes and experience of the public.
06:41But it is not translated into a new policy
06:45approach to curtailing drug violence.
06:48On going indeed worsening exposure
06:50to criminal violence affects
06:52the health of survivors as well.
06:55Rates of anxiety, depression,
06:57suicide,
06:57and trauma are widespread and
07:00growing across the country.
07:02The overwhelming emotional well being
07:05of citizens has greatly deteriorated.
07:08Journalists who cover the drug war
07:10are also struggling to trauma due to
07:13their repeated exposure to violence.
07:15Indeed, they are themselves targets of this.
07:17Violence in Mexico is now the second
07:20deadliest country for journalists
07:22in the world.
07:24Despite the urgency of these issues,
07:27only 2% of Mexico's total budget
07:29for for Health is dedicated to
07:33mental health and behavioral health.
07:36The point here is,
07:37is that violence and impunity has
07:40led to a complete lack of trust
07:42in the Mexican government,
07:44and the responsibility for Health,
07:46Safety,
07:46and survival falls directly
07:47on the people who most
07:49need support and protection.
07:54What is known or better,
07:56or more accurately put,
07:58believed about Annexus comes
08:00largely from unofficial sources,
08:02such as newspapers, televisions, and radio.
08:06There are also a few government reports Anna
08:09few medical articles in medical journals,
08:12but the pictures that these sources
08:14paint is that an exo's are overcrowded,
08:18filthy and abusive.
08:19Such depictions do not easily translate to
08:22an increased commitment to understand the
08:25conditional conditions that fuel and Nexos,
08:28nor the experiences of patients within them.
08:33Mexican authorities have a
08:34two fold approach to an exo's,
08:36both of which center on the
08:38issue of violence.
08:39On the one hand,
08:41government agencies claimed to be shutting
08:43down and excess on the basis of the
08:46violence that takes place within them.
08:48They claim to be improving.
08:50On the other hand,
08:51they claim to be improving and
08:53nexos conditions and treatment
08:55services by reading an excess of
08:58violence through scale up programs.
09:00So on the side of this slide
09:03of the right side,
09:04we see a recent and typical headline
09:08about human rights abuses in a nexos.
09:11And we also see the signing of a
09:132015 public health initiative that
09:16you that calls upon the Mexican
09:19military to close all in Nexos
09:21and to begin providing treatment
09:23prevention and and also treatment.
09:25This obviously is a very
09:27troubling alliance between public
09:29health in the Mexican military,
09:31and there's a quote from the
09:33director in this article from the
09:36National Commission on addiction.
09:38And he says we're going to close the.
09:41Famous Gran has or next shows where
09:44people have are armed in kidnapped.
09:47We have seen violence violations,
09:49robberies, and even murders inside them.
09:52For this reason, they can no longer exist.
09:56So in both of the the Max the Governme.
10:01Approaches the displacement of
10:02violence from a nexos either through
10:05closure or reform, is unrealistic.
10:08It's UN realistic because criminal
10:10violence now thoroughly saturates
10:13the communities where Anexos Art
10:15located and most densely located.
10:18The violence that is said to
10:21occur within a nexos,
10:22I argue,
10:23cannot be understood or addressed without
10:25addressing the violence that surrounds them.
10:27So in the other image to the left
10:31we see an an exo called an ex with
10:34Aviva or an exo for life or of life.
10:38There is also the Court of a mother
10:41who worked 18 to 20 hours a day
10:44to keep her 22 year old daughter
10:47in an exo and the mother says she
10:50keeps her there to keep her safe.
10:53Her daughter who I interviewed
10:54several times in an exo did not
10:57have a problem with addiction.
10:59In fact many people I met in a Nexus
11:02did not have problems with addiction.
11:05Instead this daughter and
11:07others are simply young.
11:08Poor female and live in places
11:11where violence is worse.
11:12In this case it got the pack which
11:15is just outside of Mexico City.
11:18It's a municipality with the highest
11:20rate of femicide in Mexico today.
11:23The daughter, of course,
11:24told me she wanted to get out
11:26of the index so,
11:27but she also understood why her
11:30mother wanted her to stay in.
11:32So the next Nexus that I
11:34studied were quite small.
11:36One usually usually one room, sometimes two.
11:39They typically interned,
11:40which is the official language
11:43between 10 and 30. Annex Avalos.
11:46Overcrowded and unsanitary by
11:48normative western standards.
11:49It was not unusual for NX autos to
11:52describe the in exo's better than
11:55their previous living conditions.
11:58While some enact anexos openly
12:00resented their confinement in planned,
12:02an escape.
12:03Others appreciated the more predictable
12:05and less volatile environment.
12:08The index so provided.
12:11Many talked about their fear of
12:13leaving the in exo and others
12:16talked about their desire to stay.
12:19One of the key features of a nexos is
12:21there are no professional healthcare.
12:24There's no professional healthcare oversight,
12:25and this was certainly the
12:27case in those that I studied.
12:29Rather, the counselors who work
12:31there were once an Excel,
12:32those themselves.
12:33And like in other mutual aid groups,
12:36they considered their efforts as a
12:38form of service to others as well
12:40as a necessary means of maintaining
12:43their own sobriety and mental health.
12:45Some councillors noted known as
12:47maybe a loose chose to live at the
12:50in Mexico at Indian Mexico and exo.
12:53Sorry it's very early here after they
12:56finished their round of treatment.
12:58These are these counselors
13:00leave during the day,
13:01usually in search of day labor
13:04work and return at night to eat,
13:07sleep and attend meetings.
13:09The leaders and founders of
13:11an exo's are called Petrino's,
13:13which is godfather in the
13:15Catholic sense of Godfather Hood.
13:16But it is also the term used to
13:19denote ones male sponsor in a 12 step
13:22group of female leader of an exo and
13:25a female sponsor is called a Medina,
13:28a godmother.
13:29The progression from annex otal
13:31to counselor to Petrino is
13:33the norm in the Nexos.
13:35Just as addicts in this country are likely
13:38to become substance abuse counselors.
13:41Families pay an Excel of the
13:44index was a monthly fee,
13:46usually the equivalent of 30 to $60.00
13:49and this is in comparison to private
13:52healthcare mental addiction clinics,
13:54which usually charge the equivalent
13:57of 1500 to 2000 US dollars.
14:00The families pay the in excess
14:03for their relatives treatment.
14:04They may also contribute basic
14:06provisions for their relatives care,
14:08such as food and medicines.
14:11The Nexus that I studied
14:13had weekly Visitation hours,
14:15usually a 2 hour window on
14:17Sunday and I observed some XLS
14:19receiving regular weekly visits,
14:21usually from their mothers and others
14:24who never received a visit from
14:26family and others who had their visit
14:29suspended as a form of punishment.
14:34There are an estimated 500 certified
14:37residential rehabilitation
14:38Centers for addiction in Mexico,
14:41many of which are private and inaccessible
14:45to most Mexicans in greater Mexico City
14:49and Megalopolis of 21 million people.
14:52There are just over 100 certified
14:55residential addiction treatment centers.
14:58Certification requires meeting the
15:01standards for establishing a residential
15:05treatment center as articulated in a
15:08health health care Reform Act that was
15:11passed by the Mexican Legislature in 2009.
15:15This reform is called Gnome 28,
15:18and the standards that clinics must
15:21abide by include specific facility
15:24and procedural requirements,
15:27availability of professional medical.
15:29And cycle social treatment and respect
15:33for human rights indignity of patients.
15:37So in contrast to the very small
15:39number of certified centers,
15:41public health officials estimate
15:43that there are anywhere from 1500
15:46to 4000 Anexos in Mexico City alone,
15:49and this is probably a very low estimate
15:52because there are an estimated 73,000
15:55and echoes throughout the country.
15:57As one public health official,
15:59light interviewed wanted to stay anonymous,
16:02put it to me.
16:03We will never know how many in nexos
16:06exist because they are under the radar.
16:09We do not have the capacity or the will
16:12to know anymore than we already do.
16:16What is known about an exocet is that
16:19they're most densely concentrated
16:20in poor neighborhoods.
16:22Informal settlements on the periphery
16:24of cities and in rural areas.
16:27These areas are precisely the areas
16:30that have experienced intensification
16:33of criminal violence in recent years.
16:35To varying degree degrees,
16:37these areas lack public infrastructure,
16:39schools,
16:40healthcare facilities,
16:41legal protection in legal sector jobs,
16:44so the inhabitants of these areas
16:46carry the burden of their own
16:49protection and survival, and an exo's,
16:52I argue,
16:53are a result of and response to this burden.
16:59So this slide highlights three of the
17:0116 Burrows that my study focused on,
17:04and these are shaded in blue as well
17:07as the bordering municipalities of it.
17:10Got the pack and Nessa where I also worked.
17:14The first phase of my research was simply
17:17I locating an exo's and I worked with
17:21a group of researchers distance from Unum,
17:24the major University in Mexico City,
17:26and the dots in the image on
17:28the on the right represent the
17:31number of Nexos located within a
17:33particular neighborhood neighborhood,
17:36usually consisting of A6 block radius.
17:39For example,
17:40the blue dots indicate that there
17:42are anywhere between 11 and 20 and
17:45exo's in one particular neighborhood.
17:48Keep in mind that these dots and their
17:51associated figures comprise only the next,
17:53so the research identified.
17:55So for the rest of my talk,
17:58I'm going to focus on one and next,
18:02so it's neighborhood and this is a
18:05particular neighborhood with over 20
18:07in Nexos an it's in the municipality
18:09of Ocotepeque,
18:10Mexico's largest munificent municipality,
18:13which is located 16 kilometers
18:16North East of Mexico City.
18:18So the next,
18:19so that I'm going to talk about is
18:22called Grupo San Rafael and it's
18:24located on a typical narrow dirt Rd.
18:27This neighborhood and what she
18:28does it's it's exemplifies the
18:30extreme inequality that characterizes Mexico,
18:33cities expanding urban periphery.
18:36This neighborhood has winding dirt roads,
18:39self built houses and construction
18:42ruins among littered open areas.
18:44Most of the cinder block houses are
18:47two or one rooms in size and some have
18:52rooftops made of waste materials,
18:55Cardboard and earthen floors.
18:57Water is delivered in 55 gallon
19:00drums once or twice a week.
19:03Electricity is stolen from
19:05public power lines.
19:07And garbage service is usually
19:09provided by mule drawn wagons,
19:11so the image on the left.
19:14The second building in theirs is
19:17where Grupo San Rafael is located
19:19in it's on the 2nd floor of a
19:22two story cinder block building.
19:25It's hard to see,
19:26but it's dressed with a colorful
19:28banner that openly advertise itself
19:30as a rehabilitation clinic for
19:33alcoholism and drug addiction,
19:35and that it offers vocational training,
19:37cardio and yoga.
19:39Higher up the Hill residents
19:42misses the image to the right.
19:44Residents contend with landslides every year.
19:47Such natural hazards are
19:49typical in the urban periphery,
19:52much of which is concentrated along the
19:54slopes of the surrounding mountain ranges.
19:58The image to the right.
20:00Also shows not only the dangerous
20:03homes face from landslides,
20:04but the dangers faced the dangerous
20:07residents face from femicide.
20:09The portrait of women's faces on
20:11the self made homes are of local
20:14disappeared and murdered women.
20:18So now we're going to go inside Grupo,
20:21San Rafael daily life in this in exo.
20:24Like all of the other and exercise
20:27observed is highly regimented and XL
20:29those wake eat exercise participate
20:31in 12 step meetings, nap, cook,
20:34clean and sleep in the same to at
20:37the same time each day, every day.
20:40All of these activities unfold in one room,
20:43although there is another room
20:45where the counselors and Petrino's
20:48are allowed to be in.
20:49The annex, all those were only allowed
20:51to be in one room and many were there
20:55for many months or years at the
20:57time when these photos were taken.
20:59In 2015, fourteen men and one
21:02woman shared this one room.
21:04Most had been there under six months,
21:07ifu for a couple of years and one person.
21:10The woman for over 10 years.
21:12Their ages range from 14 to 52.
21:15An most annex.
21:16All those were in their late
21:19teens and early 20s.
21:20And here we see a counselor overseeing
21:23one of the days 5 cleaning periods
21:26that counselors first time in an
21:28exo was when he was 12 years old.
21:31His father took him to one because he spent.
21:35His days sniffing solvents,
21:37which is what many of the anexos
21:42do and also drinking beer.
21:4515 years later,
21:46he had been in at least 20 and Nexos,
21:49and most of these were located in it.
21:52Got the Beck,
21:53but a few were in Mexico City proper.
21:56His last what's called internment
21:58by officials was at Grupo San
22:01Rafael and it was voluntary.
22:03He went there on his own because he
22:05sought shelter from the conditions
22:07ineffective pack which were becoming
22:10too violent and he was seeking
22:12protection for his own life via next so.
22:15Was a kind of refuge for him.
22:18This is not unusual.
22:19This is not an unusual story
22:21among annex ottosen counselors.
22:23So five years after his arrival
22:26at group of San Rafael,
22:28he was promoted to counselor.
22:31On the wall are framed religious images.
22:34Pictures of founders of the of a,
22:37a inspirational quotes and announcements
22:39of the nexos daily rules and schedule,
22:43and certificates from one anexo
22:45to another in exo.
22:47In recognition of their good work.
22:50Like other an exercise studied,
22:53Grupo,
22:54San Rafael had windows that
22:56were barred and covered.
22:59The furniture was folding tables and
23:01chairs which are used in store or stored
23:05away according to the day's schedule.
23:07Beds or blankets that are laid
23:09out on the floor as each night
23:12and an X auto spend much of their
23:15day assembly in an assembly.
23:17These household items as well as scrubbing
23:20the floors upon which they are placed.
23:24So the advertisement announced
23:25that there was cardio and yoga.
23:28An exercise was a part of the
23:31daily treatment in an exos.
23:34Exercise generally means running around
23:36in circles for at least an hour and
23:40holding their body in challenging
23:42poses for extended periods of time.
23:45If one cannot keep up with
23:48running or cannot hold
23:49their body in the required pose,
23:51they are likely to be kicked or subjected
23:55to verbal abuse so they try harder.
23:58Now keep in mind that an Excel those
24:01usually arrive very thin and they
24:03typically got thinner during their stay,
24:06making exercise extremely difficult
24:08and sometimes impossible.
24:09Others, however, gained weight,
24:11and commented that being an exo was the
24:14first time they had regular meals in years.
24:17So some people worked out,
24:19became muscular,
24:20and described feeling good and healthy,
24:23but others have very frequent
24:25illnesses and appeared to languish
24:28and get sicker overtime.
24:32So here we see what was
24:34called or is called yoga.
24:36But the real exercise of the value
24:39of this exercise is I saw it was the
24:42nonviolent touching between men.
24:44It's a form of bodily contact
24:46that was very rare for NX, autos,
24:49and sometimes entirely new.
24:51I saw I saw many men struggle with
24:54this exercise, not just physically,
24:57but emotionally and psychically.
24:59The poses always involved
25:01working with other men,
25:03touching other men and this stirred up
25:06feelings of distrust, powerlessness,
25:08fear and memories of physical abuse.
25:11It also led, however,
25:13to the recognition of the possibility
25:16of nonviolent relations between men.
25:19So I want to stress how important
25:22this possibility is.
25:23New an Excel.
25:25Those arrive in a state of extreme
25:27physical and emotional distress,
25:30a state they've been in for
25:32much of their lives,
25:34so this distress doesn't
25:36necessarily end upon arrival.
25:38Indeed,
25:38most annex tacos are forcibly committed
25:41in a manner that eerily resembles
25:43criminal tactics of drug cartels there,
25:46kidnapped, blindfolded,
25:47wrapped in a blanket.
25:49Beaten and then tossed into an exo.
25:53When I asked padrinos why they engaged
25:56in this practice of abduction and abuse,
25:59they often said that such measures
26:02were necessary given that most
26:04Alcoholics and addicts do not
26:07willingly enter into treatment.
26:09Other padrinos simply stated
26:10this is just the way it is,
26:13suggesting the normalization
26:14of such violence in both the
26:17Nexos and life in general,
26:19but other padrinos describe this
26:21practice as intentionally resembling
26:23criminal violence in order to
26:25bring the annex audo face to face
26:28with their vulnerability to it.
26:30They argued that windy in Excel,
26:32though realises that they will
26:35not be killed or disappeared,
26:37but released into an index so
26:39they are being given a chance to
26:42live clean and sober and within a
26:44community of those similarly situated.
26:48When this happens they are more
26:50likely to desire an achieve recovery.
26:54So within the next,
26:55so physical and verbal violence is
26:58abundant and it's often described
27:01as instrumental.
27:02There is a form of therapy,
27:04in fact called hard therapy
27:07or the use of Mono Dora.
27:09This is a strong hand and this is
27:12a form of treatment punishment
27:14that is meant also to encourage
27:18introspection so hard therapy
27:20can simultaneously be a form of
27:23punishment for some transgression.
27:25And a means of introspection and a
27:28pathway to humility which is deemed
27:31essential for maintaining sobriety.
27:34Other practices such as forced prolong,
27:37kneeling on sharp objects while
27:39arms are outstretched in across
27:41like figure are described
27:44interchangeably as punishment,
27:45treatment and religious practice.
27:48To the point here,
27:50is that such practices of violence
27:52incorporates off suffering the
27:54means of which is always multiple.
27:57There is an explicit attempt to
27:59give meaning to the pain that
28:02arises from these practices with
28:04these violences by transforming
28:06them into a mechanism for recovery.
28:09Many of these practices also
28:11relate to Christian,
28:13modalities of selfhood and healing
28:15that have existed for centuries.
28:18These practices are thought of in often,
28:21often not always,
28:22in moral terms and serve to
28:24establish a distinction between
28:26the destructive suffering one
28:28experiences before being annexed,
28:30Sabo and the productive,
28:32redemptive, redemptive suffering
28:33suffering of the an example.
28:38So redemption is also
28:39sought through education.
28:41Most of the annex titles that I met
28:44made it up to about the 3rd or 4th,
28:485th grade before leaving school permanently,
28:50and this is also true of the counselors.
28:54So in this image we see a counselor
28:57seated at the front of the room
29:00holding what's called class,
29:01and each day an Excel.
29:04Those are use it and either
29:06read the big book. Or the Bible?
29:09Some arrive unable to read and are
29:12taught how to read during class.
29:15Others seemed so withdrawn that
29:18they appeared to forget how to read.
29:21During study hour one,
29:23annex Otto is called upon to read aloud.
29:27Who is often extremely painful to observe.
29:30Their struggle with reading,
29:32and indeed the stigma and the shame
29:35that surrounded the inability to
29:38read was often more sort of acute
29:41than the stigma and shame of the
29:44life in general of annex autos.
29:46So in this particular case,
29:49the counselor in this photo
29:51was kind and encouraging,
29:53and he did help many and Excel those become.
29:57More comfort rible reading,
29:58or or to learn to read.
30:00But other counselors I knew were
30:03incredibly cruel and demeaning
30:04during this practice,
30:06and they made the struggle of reading
30:08the struggle of education even harder.
30:14So the one activity that takes up
30:17most of the day sometimes, and often
30:20most well into the night is testimony.
30:24And in this activity there is this activity.
30:27It's where the distinction between
30:29redemptive suffering and useless
30:31suffering simply destructive.
30:33Suffering becomes most apparent,
30:35so for several hours every day,
30:37each day an Excel,
30:39those recount and listen to the
30:41others experiences of family sexual.
30:44And criminal violence.
30:46And they often or always identify
30:49as victims and perpetrators of it.
30:52The testimonies are intense
30:54in gut wrenching and they are
30:56accompanied by screaming, weeping,
30:58smoking in intermittent stretches
31:00of a kind of shocked silence.
31:04They concern things typically shared in the
31:07recovery center setting like abusive parents,
31:09broken hearts,
31:10drug narratives,
31:11and poor health and feelings of hopelessness.
31:14But they also describe being kidnapped.
31:17Having loved ones disappear and nearly
31:19being killed or killing someone else.
31:22Personal experiences of being caught
31:25in a world of violence and a horror
31:29fear an loss that accompanies it.
31:31So the testifying annex,
31:33Otto stands behind a wooden podium and
31:36here we see a boy boy called cotorra say,
31:39which is the number 14 in Spanish
31:41and it was the age of him at
31:44the time that he was admitted.
31:48So while the testifying annex Otto
31:51stands alone behind the podium,
31:53his peers sit attentively before him,
31:55maintaining perfect posture.
31:57Their feet are flat on the floor there,
32:00their hands cut their knees and
32:03they are required to remain still.
32:06If they don't,
32:07they're typically you know,
32:09hit or made to do other things such
32:12as sleep on the near the toilet at night.
32:16There are various forms of punishment for
32:19not maintaining strict bodily comportment,
32:21which is considered a form of discipline
32:24or strong therapy that was described
32:27as having therapeutic potential.
32:31Meal time, so with the exception of
32:34learning the anexos doctrine and routines,
32:36cooking and cleaning and being inspired to
32:39open up one's own an exo in the future,
32:42there was little evidence of
32:44vocational training at Grupo,
32:46San Rafael or really any of the annex
32:49and exercise study and I always
32:51thought well of course there isn't
32:53vocational training because there
32:55is a scarcity of work in the areas
32:58in which these indexes are located.
33:01Making vocational training
33:04otherwise irrelevant.
33:06In regard to food,
33:07many media reports say that anexos
33:10provide the worst possible kind
33:12if they provide food at all.
33:15They talk about maggot infested
33:17beans and Multi Tortillas.
33:19For example.
33:20The meals are considered considered
33:22offal and are given once a day at best,
33:26but my observations offered a different
33:29story because it was usually mothers who
33:32supplied the food often as a form of payment.
33:36And they tried to make the meals they
33:38provided plentiful and nutritious,
33:40not only the steak for their
33:42children or relatives,
33:43but also so that the Annexa would
33:45accept their food as a form of payment,
33:48and they simply could not pay in
33:51the form of money.
33:53So people also in the community,
33:55the surrounding community often
33:57bartered with Ian Exo,
33:59bringing it basic supplies and offering
34:01services like washing blankets or
34:04posting advertisements with the phone
34:06number of the Petrino for future annex Atos.
34:09And they did this in exchange
34:12for various kinds of help.
34:14Many women did this to have their
34:17husbands taken in their abusive
34:19husbands to be taken into the index.
34:22So an.
34:23And taught and punished for abusing them.
34:26But other people sort of called upon
34:29future favors the nature of which
34:31I did not know or inquire into,
34:34because you know some of these
34:36places could be quite shady,
34:38so it wasn't just you know,
34:41healing and treatment that was
34:43occurring in many of these,
34:45so we're also forms of Labor and
34:48business that was on the side that
34:50I that I simply did not want to
34:53engage with for safety issues.
34:58Let's see, why can't I move forward?
35:16Angela, you're on mute.
35:22Angela, you're muted.
35:37Should be right on the bottom of your
35:39screen. There should be a mute button.
35:43Yes, there we go great.
35:45So I wanted to go back briefly to Katha,
35:48say and tell a little bit about his story.
35:51His mother had him abducted when
35:53he was 14 and taken to Grupo
35:55San Rafael and she did this.
35:58She told me because within one
35:59year her eldest son was murdered
36:02and her daughter disappeared.
36:04See, she simply feared for Ecuador,
36:06says life, and she saw the in exo as
36:08her only hope for keeping him alive.
36:11When I asked her if she worried about
36:14the negative effects of him being in
36:17an exo and how this might affect him
36:20because many people were deeply affected,
36:23often a negative ways. She told me.
36:25Of course I'm concerned,
36:27but what is my alternative?
36:29There simply is no alternative
36:31when I ask a tortoise say how he
36:34felt about his mother and her
36:36decision to commit him to the index.
36:39So he simply shrugged his shoulders.
36:41But then several hours later he
36:43came up to me and told me that he
36:46wished his mother had put his brother
36:48and sister in the index, so too.
36:53So in this slide we see.
36:58What is going to be night time sleeping,
37:01which is usually about 6 hours a
37:04night and everyone sleeps on the
37:07same floor where everything else
37:09in the day had had taken place.
37:12An I just want to end with this
37:14slide an ask some questions and these
37:17questions are really you know how can
37:20the forcible or compulsory detention
37:23or and the infliction of violence
37:25on an Excel those in an exo serve
37:28as a reproach to the world at large,
37:32in which the in exo is situated.
37:36At times or even how can it serve as
37:39our approach to a nexos themselves?
37:42Anna times the answer to this
37:45question was very unclear to me,
37:47but some of the practices that
37:49I've described are conceived as
37:52moving the annex auto away from the
37:55destructive violence of the community
37:57of the world at large of Mexico.
37:59Torbe recovery, safety and survival.
38:02This occurs in part through
38:04the control of 1's behavior.
38:06Behavior and movements in accordance
38:08with guidelines based on feelings
38:11of shame and fear.
38:12But it also occurs through the
38:15confession of intimate suffering,
38:17the rendering and witnessing of unthinkable,
38:20personal experiences with violence which
38:22are ultimately revealed to be shared.
38:26Overtime this sharing,
38:27I think enables a new mean of violence
38:32that is latent with the possibility of
38:36something more than than violence more
38:39than a destructive effect of violence.
38:43So nevertheless,
38:44not an not all anexos are the same and
38:48not all people in the next to suffer equally.
38:52An established do try to escape
38:54and depending on the facility,
38:56they sometimes are successful.
38:58Those who fail or return often on
39:01their own will are sometimes changed
39:03to a wall for periods of time to
39:06prevent future attempts of escape.
39:08That's true,
39:09it suggests that an excess or simply
39:12spaces of healing fashioned out of the
39:15resources at hand is not to say that
39:18they are fraught with terrible dangers.
39:21Rather,
39:21it's to draw attention to how the nexos
39:24therapeutic strategies utilized the
39:26indeterminate nature of violence as a
39:29means to secure survival and recovery,
39:31which is also in this setting and
39:34in this world also indeterminant.
39:37So in conclusion, I want to.
39:39Say that you know Grupo San Rafael
39:42shares all of the characteristics that
39:44I observed in nexos throughout Mexico
39:47City and the surrounding municipality.
39:50Namely,
39:51it exists in violent zones
39:53that are dramatically poor.
39:55An unequal it uses coercion,
39:57lacks professional healthcare
39:59providers or oh.
40:00Our site and deprive Zanuck silos
40:03of what in the US we call Liberty,
40:07but the actual conditions of an exo's
40:10and the experiences of an examples
40:13within them vary considerably,
40:15so uniformly casting all in exo's as prisons,
40:18labor, farms,
40:19or hell as they are typically described,
40:22obscures this diversity and ignores
40:25the Benevolent impulse of many
40:28and Nexos and empathy Nos.
40:30From the point of view of many
40:33Mexican families who turned to an
40:35exo's as well as the people who
40:38run them, the indiscriminate condemnation
40:40of annexus does not protect the NX.
40:42All those within them, On the contrary,
40:45it makes them more vulnerable to the concept
40:48of concrete consequences of untreated
40:50addiction and the risks of violent crime.
40:54And also the stigma that is
40:56associated with the poor.
40:58It's unclear how well anexos rehabilitate,
41:00and examples.
41:01Certainly the physical conditions
41:03of these centers are suboptimal
41:06according to US standards,
41:07and the use of coercion calls into
41:11question their ethics and Efficacy.
41:14But the fact that some of the
41:17annex titles voluntarily submit to
41:20detention to receive assistance,
41:22be it shelter, food, bedding,
41:25help detoxing or relative safety
41:28demonstrates the degree of
41:30precarious precariousness of life
41:32outside of a nexos Now this is not
41:36to downplay the an exo sub uses,
41:38but for those who enter voluntarily and
41:41even for those who do not be an exo
41:44functions more as a shelter than at clinic,
41:47more as a refuge from violence
41:50than a vehicle for it.
41:52Many parents asserted that their
41:54children were safer locked up in
41:57a nexos then free on the streets,
42:00suggesting a profound disconnect
42:02between universal ethical principles,
42:04principles of coercion and Liberty,
42:06and these and the local realities
42:09that their families confront.
42:11So given the multiple and complex
42:14needs of an exo, sanic silos,
42:17and the community in which they are situated,
42:21what does addiction recovery?
42:23Actually require an consist of and
42:26how can this recovery be regulated
42:28in this milieu?
42:30And that's part of what my research
42:33is currently examining,
42:34so the harsh realities inside
42:36it and exo's have been gradually
42:38coming to the attention not only
42:41of Mexican health authorities,
42:43but also international bureaucratic
42:46organizations like the Organization for
42:48American States of American States and
42:51in 2010 the oas launched in Mexico.
42:53A training and certification program
42:56for unreg certified residential
42:58addiction treatment centers.
43:00This program, which is known as processor,
43:03was led by the oas is Inter American
43:07drug abuse control Commission and
43:09I was able to the beginning of the
43:14program follow some of the addiction
43:17in public health specialists who
43:20began to systematically locate
43:22rehabilitation centers across Mexico.
43:24And also conduct a needs assessment
43:27survey of the services they offered
43:29with the goal of developing a more
43:32empirically based training curriculum
43:34for counselors to provide better
43:37services and to reduce violence.
43:39These surveys were conducted or
43:41piloted in in six States and I was
43:44able to observe this pilot project
43:46and there's a complex story here
43:49that deserves a lot more attention.
43:51That then I could give now,
43:53but I want to highlight a couple
43:56of points about the Procera program
43:58in about these surveys.
44:00There were many,
44:01many municipalities that field
44:03workers could not enter because they
44:06were considered too unstable and
44:08these are the precise areas these
44:11inaccessible locations that are the
44:14places where Anexos are most densely
44:16concentrated of the 2500 resident new
44:19residential establishments that were
44:21newly identified through this program,
44:23less than 10% were registered
44:25with or certified by any
44:28authority. Some states, including Oaxaca.
44:30Had no certified programs at all an at
44:34the certified centers that were located.
44:37These two violated requirements of Nome 28.
44:41The physical conditions of Mexico's rehab
44:44centers, including the certified ones,
44:46were revealed to be tearable There
44:50was also the significant issue of the
44:53epidemic Epidemiology of addiction itself.
44:55Because the survey found that crack
44:58cocaine and meth were used much more
45:01than Mexico's national addiction survey,
45:03that was that previously indicated
45:06and consistently does that.
45:07Alcohol, tobacco and marijuana are
45:10Mexico's primary drug problems.
45:11Finally, and most importantly,
45:13when the data from the initiative
45:16was analyzed and written up the
45:19Mexican government.
45:20Along with federal health agencies,
45:22prohibited its public distribution.
45:25So in sum,
45:26the report reflected the violence of
45:29Mexico's longstanding inequality.
45:30Zanin prohibiting the distribution of it.
45:33Mexican authorities effectively
45:34reinforced the illegality of the
45:37system they sought to reform.
45:39When I asked the Petrino of Grupo San
45:42Rafael what he thought about this,
45:44what he thought about the Gnome?
45:4728 he's only remark was that it caused
45:50him more trouble than it helped.
45:53He said that he feared visits
45:55by inspectors from the federal
45:57Sanitation Committee.
45:58Who are in charge of informing
46:02of enforcing reforms?
46:04And also described in Gnome 28.
46:07He and he said that the Sanitation
46:12Committee extorted and exo's
46:14his and others for money.
46:17So Meanwhile,
46:18several Mexican health authorities
46:19I spoke to stated explicitly that
46:22the Mexican government could not
46:24practically shut down in Nexos because
46:27there simply aren't any alternatives.
46:29Reflecting exactly what mothers
46:31and Families said that I spoke to
46:34in the municipality of Ocotepeque
46:36one and exo was closed down by
46:39police for exploiting the NX.
46:41All those by forcing them to work packaging
46:45retail goods for local businesses.
46:47The very next day,
46:49the parents of the neighborhood
46:51rioted in the streets,
46:52refusing to let cars or buses pass on the
46:55main road through their neighborhood.
46:57They demanded that the index to
47:00reopen because after it was closed,
47:02there was nowhere else for them to
47:05take their children to keep them safe.
47:07So stories like this convey the
47:09sense of normality of an exo's.
47:12The local demand for their services
47:14and the challenges of holding the
47:16index was accountable to conventional.
47:18Or universal norms of public
47:21Health and Human rights.
47:23So the challenges of addiction and
47:25recovery in Mexico make clear how
47:28socially and politically embedded
47:30mental illness and substance abuse is,
47:33and my ethnography reveals the huge
47:35Gulf between a nexos and contemporary
47:38paradigms of addiction medicine.
47:40So much research is essential for
47:42bringing into focus the suffering and
47:45challenges of families in neighborhoods
47:48while making sense of these narratives
47:50and how they relate to the context.
47:53That produced them produced the suffering.
47:56Explanations for the Gulf between
47:59health realities and regulatory
48:01ideals must include assessments
48:03of the systematic forces that
48:05produce and maintain marginality
48:07and vulnerability of those who are
48:10forced into and seek out and Nexos
48:13and this appraisal is especially
48:15relevant today as problems
48:17with addiction grow in Mexico
48:20and criminal violence worsens.
48:23So that is the end of my.
48:28Official part of this and I am
48:31going to stop sharing somehow.
48:35Stop by pushing stop sharing OK?
48:40Perfect thank you so much.
48:42Professor Garcia for a
48:44wonderful presentation.
48:45Extremely thought provoking so I'm
48:48interested in hearing from everyone all
48:52the questions that you have please.
48:54And put them in the chat.
48:56You can speak up, or you can raise
48:58your hand or Trisha will help identify
49:01people who are raising their hand.
49:03So yeah, please please ask some questions.
49:10So we do have a question from doctor San
49:12Anna, which is what is the average length
49:15of stay for attendees in an exo San?
49:17How much time out of the building is allowed?
49:21So the average length of stay is
49:24anywhere between three to six months,
49:26but as I mentioned,
49:28there are some people that I met
49:31were in a Nexus for years and most
49:34in Excel those cycle one and exo
49:37to another to another to another,
49:39and so much of their life is
49:42spent in an ex source.
49:44And this was.
49:45You know every counselor that I talked
49:49to everyone that you know that I talked
49:52to had been in an exorcist or 2030
49:55years before moving up and becoming a,
49:58you know a professional worker up some.
50:00Once within the next so.
50:04The other question of the amount of time
50:08outside, so only people only counselors
50:11were considered media lose who can go
50:14outside in search of work during the day
50:17are officially allowed to go outside,
50:20but the other opportunity to go outside
50:23was with the weekly visits with families,
50:27and many of those visits took place outside.
50:30They were heavily observed by counselors,
50:33so people couldn't escape.
50:35But they did take place, usually outdoors.
50:38There were off.
50:40There were also yearly celebrations on
50:42the day of the Nexos establishment,
50:45and sometimes these would take place
50:48in the community under a big tent.
50:51There would be music and food,
50:54so this establishment of the index so
50:57was considered a yearly celebration,
50:59and those were also opportunities
51:02for being outdoors.
51:05Excellent in doctor.
51:06DS has a question about what the
51:08financial support for Nexuses,
51:10which is interesting question
51:12and also have there been any
51:14initiatives to regulate them,
51:16presumably by the state,
51:18but also potentially
51:19communities, yes.
51:20So this is, uh, so families would
51:24pay a monthly fee if they could.
51:27So there that that helped with
51:30the functioning of the index.
51:32So and these typically were between
51:3630 and $50 US dollars a month.
51:39Those counselors who were able to
51:42leave during the day in search of
51:45work were expected to type some
51:47of their earnings into the index.
51:50So for their own upkeep for their food
51:53for their ability to sleep there overnight.
51:57And there was a sense that,
51:59like in many mutual aid groups,
52:02that the family and the community
52:04and the annex, all those themselves,
52:07once they become counselors,
52:09were were supporting.
52:10The next so that said,
52:12I'm sure that there were other
52:15forms of financial support.
52:17I did see exchanges of money
52:19related to that would seem to be
52:22unrelated to the treatment or
52:25upkeep of a particular person.
52:27I tended to not ask about
52:30these due to safety concerns,
52:32but they definitely were were clearly
52:35visible to me and not in all indexes,
52:39but in some of them,
52:41particularly those that were located.
52:43In Mexico City proper.
52:47And in terms of initiatives,
52:49official initiatives.
52:50Q close to regulated Nexus.
52:52There is the initiative of
52:55closing all of them,
52:57which is the key initiative that
52:59is currently in place and utilizes
53:02again the Mexican military to
53:05identify enclosed in Nexos,
53:07often very violently.
53:09Terrifying the communities in
53:11which the indexes are situated,
53:13forcing them ultimately to become even
53:16more underground in order to remain open.
53:19And the other.
53:21There are some upscaling initiatives
53:24that have been funded by the sort
53:28of local governments that sent
53:31that essentially seek to improve
53:34the physical conditions of the
53:38indexer and community.
53:40Residents also participate.
53:41For example in when there is an
53:46issue with flooding or when.
53:49You know there's cracks in the
53:51wall and an water you know is
53:54seeping into the building,
53:55which is a yearly occurrence
53:57in during the rainy season.
53:59People from the community will
54:01come an in help repair the physical
54:03structure and the other primary way
54:06that the community sort of help with upkeep.
54:09We could stay with.
54:12Keeper upscaling the index so was
54:15through donations of furniture
54:17of food and these were considered
54:20locali within the community as being
54:23as important as some of the things
54:26that the reform bill passed in 2020.
54:29Oh, nine were, you know,
54:31insist upon such as limiting
54:34the number of an ex autos,
54:37making sure that there is a
54:40bathroom for men and women.
54:43Separating genders at during night,
54:45keeping files, etc.
54:47These are the kinds of procedural
54:50requirements that are officially demanded,
54:53and these simply were never instituted
54:57in any of the indexes that I worked in.
55:02Also,
55:03really,
55:03upscaling was something that the
55:05community had to do itself.
55:08There is another question someone
55:10wanted to know how you were received
55:14by the annex autosan the padrinos.
55:17It took a good two years for
55:20me to get in ultimately,
55:22and one of the reasons I
55:25was admitted or let
55:27in was because of my work.
55:30My previous work,
55:31and because I would talk about my own
55:34personal experience of coming from
55:37a family that struggled for really
55:40generations with opioid addiction.
55:42And so it was my personal relationship
55:46to the to the issue of addiction.
55:49Poverty intergenerational.
55:54No drug use that ultimately got me in so
55:57it was really personal connections and I
56:00was seeing a sensually as a God daughter.
56:03I was often called, you know,
56:05God, daughter, Ajita.
56:07And the relationships that I had within
56:11Nexos and were were very strong.
56:14I had I'm friends with a lot of
56:17Expat journalists in Mexico City.
56:19They often asked me to get them in
56:21for their own stories an I tried
56:24and they were always refused.
56:27So it's I was very lucky to get the
56:30kind of access that I was given.
56:33No one cared that I taught at Stanford.
56:37I'm a professor at Stanford that
56:38was that did not make a difference.
56:40What made a difference was my
56:42personal connection to the issues.
56:46OK, are there fiscal beneficiaries?
56:48Is there a group that benefits
56:52financially from the system?
56:55Yes, I mean ultimately this is a job for.
56:59Peggy knows an counselors there.
57:01Given money, they have a kind of salary
57:05that they are able to depend upon.
57:09There are likely other beneficiaries that
57:11I don't know that I didn't inquire into.
57:14You know who else is profiting from this?
57:17I will say if there are profits,
57:20they appear to be very meager because of
57:23the physical conditions of the innexus.
57:25I was able to visit Petrino's in their homes.
57:28I saw the physical conditions of their homes.
57:31Which were, you know there were no S
57:34Fancy S movies or houses with big gates.
57:37I mean these were people who
57:40live within the community.
57:42But I I can say with some certainty
57:45that there are likely others because
57:48of the nature of the economy,
57:51the informal economy,
57:53and in Mexico people are, you know,
57:56working on multiple fronts to make ends meet,
57:59and I know that this form of work
58:02was one of various forms of work
58:06that people who opened and directed
58:09that Anexos were part of.
58:15I'm going to group start grouping
58:17some of the questions because we
58:19have a lot coming in in a skip down.
58:22A little bit will try to hit
58:24all of them if time allows,
58:26but there's two questions about
58:28religion and then will get.
58:29I see doctor Jordan Razor hands
58:31so we'll get to her next.
58:33But there's two questions.
58:34One is a challenge sort of challenging.
58:37Question is how is religion
58:38utilized in an environment in
58:40which an Excel those are not
58:42allowed ownership of their bodies,
58:44whether in the Knicks or outside of it?
58:46And then the second question is,
58:49is there any connection to local
58:51churches and is there any faith based
58:54teaching program in the annexus?
58:57If you could elaborate on that,
58:59sure. The question of bodily
59:02ownership is really interesting.
59:04It's actually something I'm writing about
59:06right now in relation to Catholicism,
59:09because most of the indexes
59:11that I worked in were.
59:14Oriented to Catholicism and not
59:16evangelicalism, which is been
59:19the primary source in Guatemala.
59:21For instance,
59:22most identify as evangelical,
59:25the ones in Mexico tended to be Catholic.
59:30And within the Catholic tradition,
59:32particularly sort of the old
59:35tradition bodily ownership.
59:39You know there's a question about whether
59:42one has ownership of their own bodies,
59:46particularly within this sort of
59:48public popular strain of Catholicism,
59:50that these indexes abide to Ann,
59:53and there is traditions where part
59:56of religiosity faithfulness is to
59:58essentially give up once bottle.
01:00:01Ownership and so this is,
01:00:03you know, like I said,
01:00:05This is a tradition that goes back centuries,
01:00:08and although you know Saint
01:00:10Augustine and some of the people
01:00:12that would go into cells and or
01:00:15the penitentes northern New Mexico,
01:00:17which is who I grew up seeing their self
01:00:20flagellation the religious processions
01:00:23where where brutality essentially
01:00:25of the body was key to faithfulness.
01:00:28So what I witnessed in an excess
01:00:31was slightly different,
01:00:33perhaps because they were unable
01:00:35to express their religion.
01:00:37Their faithfulness outside
01:00:38of that circumscribed space,
01:00:40and they were essentially forced to do
01:00:43so at different points during the day.
01:00:46There were prayers before every meal
01:00:48before going to bed before going to school,
01:00:52and will be in that class.
01:00:55I showed a slide out,
01:00:57so prayer was a.
01:00:59Huge part of the experience being
01:01:02there as well some and the names of an
01:01:05exo's tend to be the names of Saints,
01:01:08so send offers by L.
01:01:12San Cristobal all indexes that I
01:01:15worked in most of them rather had
01:01:18a name of a St and they also had
01:01:22alters the from the Virgin Guadalupe
01:01:25to send them where they so you know
01:01:28it was a mix of various kinds of
01:01:31religious practices and iconography
01:01:34that that was that are visible anexos.
01:01:37They were all also so when I
01:01:40mentioned the yearly celebrations.
01:01:43So the founding dayavan.
01:01:46So sometimes those did take
01:01:49place in a churchyard.
01:01:51Yeah,
01:01:52you're a church or they were a
01:01:55priest would come and speak a few
01:01:59words so there were connections
01:02:01between churches and Anexas.
01:02:04This is something that I saw more regular,
01:02:08more frequently in the sort of the
01:02:10Minisa Paletti's on the urban periphery.
01:02:13I saw it less frequently in Mexico City,
01:02:16although within Mexico City there
01:02:18were some of these same religious
01:02:21practices in the index,
01:02:23so that used the body and also you
01:02:26know images of various Catholic
01:02:28Saints were abundant with Indian Exo.
01:02:32Did I hit both?
01:02:33The only
01:02:34other, maybe local churches
01:02:36are they? Are they involved in
01:02:38so as I mentioned during
01:02:40the yearly celebration,
01:02:41they were often involved.
01:02:43A priest would come and say a few words.
01:02:48And but again, that typically
01:02:50happened in the urban for free,
01:02:53and in some of the rural I did I
01:02:56did study some Nexus in Wahaka
01:02:59in deep up into the mountains
01:03:02and there the church was much
01:03:05more involved in rural areas.
01:03:10Doctor Jordan would you like to ask
01:03:13your question?
01:03:13Thank you so much and I'll be brief.
01:03:17Professor Garcia.
01:03:17I truly enjoyed your your talk today.
01:03:20I think you did an amazing job
01:03:22being neutral but also culturally
01:03:24affirming and presenting the
01:03:26information in the most objective way.
01:03:29So kudos to you because I think that's not
01:03:32an easy feat and I deeply appreciate that.
01:03:37I. Had so many visceral responses
01:03:40to the information presented,
01:03:42I felt myself an addiction psychiatrist
01:03:44feeling very angry at some points.
01:03:46Heart and satin.
01:03:47But I think one of the things,
01:03:50and it's just a comment, not a question,
01:03:52but I'd love for you to offer any reflection
01:03:56is when there is a lack of public health,
01:03:59infrastructure or railway for the
01:04:01government to take addiction seriously.
01:04:03The community does what it can to
01:04:05take care of their people, and so.
01:04:08Um, within my anger.
01:04:10I also felt kind of really.
01:04:15Grateful that the community
01:04:17with very little resources did
01:04:19what they needed to do in order
01:04:21to take care of their people,
01:04:23and so I often think about like
01:04:26historically excluded population identity,
01:04:27such as people with substance use disorders,
01:04:30how their humanity is not respected in.
01:04:32Even though this is not the most
01:04:34ideal way to take care of people
01:04:37with substance use disorders,
01:04:38I also felt grateful to use that
01:04:42little resources to do well so.
01:04:44I'd like to just say.
01:04:48What would you like for for the
01:04:51government to take away from this?
01:04:53What would you like for us to learn?
01:04:57And then how are you sharing
01:04:59your findings with the community
01:05:01in which you've been studying?
01:05:03Thank you so much.
01:05:05Thank you, I too have very strong
01:05:08with his responses and will say that
01:05:11working within these spaces was was
01:05:14very difficult and I would often
01:05:17leave feeling really disheartened.
01:05:19Not just because of what I saw,
01:05:22but because of what I wasn't seeing.
01:05:26I wasn't seeing any anything other
01:05:28than the condemnation of these places,
01:05:31which I which is building on, I think a.
01:05:35Very long history of you know,
01:05:38the marginalization of the poor
01:05:41in in Mexico and that's something
01:05:44I wasn't able to get into.
01:05:46Which is the history of mutual aid
01:05:49within these communities and how
01:05:51it stems from government neglect
01:05:54essentially which is increasing, you know.
01:05:57The cutting of 75% of services
01:06:00for women and children.
01:06:01For example,
01:06:02the cutting of the health care budget,
01:06:05which is also happened so the community
01:06:09does do its best to help and I try to,
01:06:12you know,
01:06:13one of the things I try to do is I
01:06:17saw a lot of illnesses and I did
01:06:20work with at various points with a
01:06:24physician and also a psychologist
01:06:26who work came in.
01:06:28And did some field work with me and.
01:06:31You know there were people,
01:06:34for example with epilepsy,
01:06:35and so I did some work trying to
01:06:39destigmatize seizures and to try to
01:06:42help differentiate between seizures
01:06:45and drug or alcohol withdrawal.
01:06:48So there was some kind of basic
01:06:51medical education that I and
01:06:54my colleague Brian Anderson,
01:06:56who's a doctor tried to offer.
01:06:59I brought medicines for diarrhea.
01:07:02For for asthma, asthma it was a huge problem.
01:07:06So there are other conditions that
01:07:09I felt that I could address by
01:07:12providing you know, basically medicine.
01:07:17But the takeaway for me, what is that?
01:07:22You know the violence that is
01:07:25highlighted and the in the in the
01:07:29spaces by the Mexican government.
01:07:32The kinds of narratives that
01:07:35are drawn aponta condemn.
01:07:37These places are as form
01:07:41of violence in themselves.
01:07:43In and of itself,
01:07:46and so I've begun publishing
01:07:49some of my findings in Mexico
01:07:52in Spanish and I have been.
01:07:55Largely condemned for my work,
01:07:57I have been called unethical.
01:07:59I have been told that I should not have
01:08:03any sympathy for these places that I know.
01:08:06These places need,
01:08:08not an anthropologist,
01:08:09but the police.
01:08:10So my work has not been received very well
01:08:14at the same time I've met researchers,
01:08:18psychologists,
01:08:18epidemiologists who have said we wish
01:08:21we could do this kind of research.
01:08:23But we will not be supported to do so.
01:08:27So it takes somebody from the outside
01:08:30to come in to do this kind of work.
01:08:34So there are other people that
01:08:37really appreciate it and want to
01:08:39have reforms that really keep in
01:08:41mind the realities of the people.
01:08:44That depend on these places
01:08:46and also who have become
01:08:48activist. You know part of the peace
01:08:52and Justice Nonviolence movements
01:08:54and in fact a lot of the women
01:08:56in it got to pick who are at risk
01:09:00of femicide are also activists.
01:09:02They often leave the annexe.
01:09:04So knowing that they were
01:09:06there because of safety issues,
01:09:08they often leave the in exo and
01:09:10become a part of the growing
01:09:13movement of women against.
01:09:15Violence against women so.
01:09:17You know there's just so many
01:09:20things going on.
01:09:22It's it's.
01:09:23It's hard, you know.
01:09:24I often felt incredibly overwhelmed by the
01:09:27amount of work that needs to take place.
01:09:30The amount of understanding that
01:09:32needs to be had an my incredible
01:09:35frustration that it's that it all
01:09:38seems sort of at times impossible,
01:09:40and that my research,
01:09:42which is like one of the only there,
01:09:45are very few studies on these places.
01:09:49You know,
01:09:49I wonder sometimes what what it
01:09:51might actually be able to do,
01:09:53if it might be able to do anything.
01:09:55It's sometimes very disheartening.
01:09:58I guess that's my my best answer.
01:10:03OK, another question. In chat.
01:10:04Do annex ottos ever age out of the system?
01:10:08And what happens as they get older
01:10:11and perhaps have more medical needs?
01:10:14That is a really great question too, and.
01:10:19It was hard so for the person that was
01:10:2152 years old there are some antics
01:10:23autos I met who didn't know their age.
01:10:25They had been in the next source from so long
01:10:28that they don't remember how old they were.
01:10:31And that may partly be because of some
01:10:33mental health conditions that they also had.
01:10:35But it could also be the disorientation
01:10:38of being in one room for so many years.
01:10:41But so for people that were,
01:10:44say, over the age and young,
01:10:46I mean old in this population.
01:10:49Because people die because 20%
01:10:51of the people killed are minors.
01:10:53Old may mean 30.
01:10:55The idea of the elderly of age is
01:10:58really different in this context,
01:11:00so but for people who have been
01:11:03there for many years, absolutely,
01:11:05you know they they health the wearing
01:11:08engineering on the body up from having
01:11:11to sleep on the floor for example,
01:11:14was really apparent an at one point during
01:11:17my research I worked with an architect.
01:11:20Came in,
01:11:21it was trying to figure out how can we
01:11:24reconfigure this space to make it more
01:11:27hospitable to the physical bodies of
01:11:30people that were clearly wearing from,
01:11:33you know,
01:11:34having to sleep on these floors,
01:11:37having to perform exercise,
01:11:38but you know in this very
01:11:41constrained environment an you know
01:11:43mental health conditions.
01:11:45Clearly you know the mental health
01:11:48conditions seem to be most acute.
01:11:50We,
01:11:51the very young and the
01:11:53very old and again old,
01:11:55meaning someone over the age of between
01:11:58the ages of 30 and safe mid 50s.
01:12:02And those kind of in between sort of
01:12:06appeared to sort of be in better condition
01:12:11and they did have the hope of leaving.
01:12:16Young very young people had the hope
01:12:19of escaping or not a scaping being
01:12:22being maintained in this space.
01:12:24To be continued to for safety reasons,
01:12:26and the people that have been there for
01:12:30long periods never really talked about
01:12:32leaving many of them seemed to be.
01:12:35They were often people who didn't
01:12:37get weekly visits.
01:12:38I was able to meet with some of the
01:12:41families of people that were saying
01:12:44their 40s and 50s and families talked about.
01:12:47You know,
01:12:48we did sort of grown tired of the visits,
01:12:52but they kept up with the monthly payments
01:12:56in order to keep their kin there,
01:12:59often because they just couldn't handle it.
01:13:02They just couldn't handle the various
01:13:05conditions that their relative
01:13:08was was dealing with.
01:13:10Professor in horn has a question
01:13:12she has her hand raised.
01:13:16Hello Hi. Professor Garcia.
01:13:19Fellow medical anthropologists.
01:13:20I really appreciate your being here.
01:13:22And that was an incredibly
01:13:24powerful talk and I can't see you.
01:13:26But I see you up here.
01:13:28You know, I wanted to sort of insert
01:13:31some anthropological discussion into this
01:13:32because your work is making me think of
01:13:35Joao Biehl's famous study Vita in Brazil,
01:13:37and he describes a place somewhat like this,
01:13:40but he describes it as a zone of social
01:13:43abandonment and what really struck me,
01:13:45especially in the comments,
01:13:46that you just made,
01:13:47is really many of these young
01:13:49people are not there.
01:13:51Abandoned by their families or given
01:13:52up on me so really instances a lot of
01:13:55moms trying to protect their kids from
01:13:58being killed or disappeared or whatever.
01:14:00Very different and I, you know,
01:14:02I thought it would be interesting
01:14:04to hear some comments on that.
01:14:06And I'm also thinking Stanley Brandes,
01:14:08one of our old professors at Berkeley.
01:14:10He worked with Alcoholics,
01:14:12you know, mostly older men,
01:14:13and I was wondering just about a a,
01:14:16you know,
01:14:17the sort of conventional sort
01:14:18of means of treating addiction,
01:14:20which I think is very powerful.
01:14:22In Mexico, is my understanding.
01:14:24If you could kind of connect your
01:14:26new research and some of the other
01:14:29anthropological work that's been
01:14:31done in Latin America on addiction
01:14:33on you know these own sort of
01:14:35similar annex type zones and you
01:14:37know maybe spell out a little bit
01:14:40of the differences between other
01:14:42anthropological work and your own.
01:14:44And I also play the cello.
01:14:45I see you play the cello.
01:14:49I have a very small office,
01:14:51so the cello is there. Um, yeah.
01:14:54I mean, I've talked a lot,
01:14:57which while about the differences in
01:14:59these space in these environments,
01:15:01Vita and the kinds of places
01:15:03that I work in and you know,
01:15:06one of the things that are often
01:15:09anexos are described in the media as
01:15:11garbage dumps where people just dump,
01:15:14you know there can or whatever,
01:15:16and they're they're really
01:15:18not families work very,
01:15:19very hard to keep people in their relatives,
01:15:22their children inside,
01:15:23especially mothers.
01:15:24Who often were working 2 three jobs you know,
01:15:28often very risky jobs in order to keep their
01:15:32kids inside and then again at the community
01:15:36is also participating in these in the upkeep.
01:15:39In the of these places.
01:15:42So these are not as far as I'm concerned,
01:15:46places of abandonment,
01:15:47and in fact a lot of
01:15:49mothers that I talked to.
01:15:51They will talk about how their only
01:15:54other option was to abandoned their kids
01:15:56and they knew that to do so would lead to,
01:16:00you know, most likely disappearance or death,
01:16:02and so that was just something
01:16:04that they could not imagine doing.
01:16:07And I think part of that has to do
01:16:10somewhat with the ideas of the.
01:16:12And traditions of the Mexican family.
01:16:15The responsibility of mothers you know.
01:16:17And it was also really a burden for mothers.
01:16:20That was the other thing that I recognize
01:16:23is that while they were helping,
01:16:25they were also very much hurting.
01:16:28And that was part of like I've been so
01:16:31frustrated with the new administration
01:16:33because I feel like it's ultimately just
01:16:35completely disavowing the struggles
01:16:37of women in India in particular.
01:16:40Stanley Brandes his work was really,
01:16:43you know.
01:16:44We've talked a lot as well,
01:16:47and one of the things that he
01:16:50noted and then I did some research.
01:16:53The beginning of my project was tracing
01:16:57the relationship between an exo's and EA,
01:17:00and so an exo's were ultimately
01:17:03sort of conceived in the 70s through
01:17:06a culturally adapted form of AA
01:17:08that responded to the particulars.
01:17:11Of poor, often marginally housed Alcoholics,
01:17:15and these groups were called 24
01:17:18hour groups where AA meetings were
01:17:22around the Clock and not like 1 1/2
01:17:26hours like they are more typically,
01:17:30and they also offered an exo's
01:17:33for participants to sober up,
01:17:36but they usually just stayed
01:17:39for a week or maybe 2.
01:17:43And then would leave so.
01:17:45So the origins really come from EA
01:17:48and EA is very much alive in these places.
01:17:52Now the EA international organization,
01:17:55the official organization,
01:17:57has called for a Nexus to stop using the a.
01:18:02Signature you know signifier because
01:18:05they call these groups pirated?
01:18:07They're not official.
01:18:09An in fact, most AA groups in Mexico are
01:18:14not officially linked to be a organization,
01:18:18there's sort of their own thing,
01:18:21and because of the international
01:18:23condemnation of an Exocet is growing,
01:18:27EA has even filed lawsuits against
01:18:30some of these places.
01:18:32They've.
01:18:32Not gone anywhere,
01:18:34but it's more symbolic button next
01:18:36to you know, often advertise the on
01:18:39their signs so it'll be a A or will
01:18:43say you know 24 hour groups or it will
01:18:47say for an 5 which are the two steps
01:18:50the 4th and the 5th step which are
01:18:53most often practiced in these groups.
01:18:57Yeah. Thank you, thank
01:18:59you. OK, I think I don't wanna
01:19:02take too much of your time.
01:19:04There are a lot of questions,
01:19:06so I might just to close it out and this
01:19:08this will be our last set of questions.
01:19:11Just Group A few questions
01:19:13and you can respond to them.
01:19:14You know, whichever parts of
01:19:16these questions you would like.
01:19:17Don't feel like you need to be exhaustive.
01:19:20We had one question about sort of
01:19:22looking at a nexos outside of Mexico.
01:19:24Are there examples?
01:19:25I think you briefly mentioned Guatemala,
01:19:27but are there other examples?
01:19:28Potential similarities and differences and.
01:19:30What we know about them?
01:19:33Another question about becoming
01:19:35a counselor or a pod Reno.
01:19:38What are the requirements for that?
01:19:42And sort of, how does that process work?
01:19:48OK, and perhaps yeah,
01:19:49let's let's leave it at that.
01:19:51There's a lot of questions,
01:19:52a lot of enthusiasm,
01:19:53but I don't want to overwhelm things.
01:19:55So whatever part of that you would
01:19:57like to respond to, well,
01:19:58I'm glad someone mentioned
01:19:59in exo outside of Mexico.
01:20:01Because there are many in the US.
01:20:04And in fact, several people that
01:20:07I talked to that I interviewed
01:20:10anexos their first experience in an
01:20:13exo was either in a place like El
01:20:17Paso or Los Angeles an I have done
01:20:20research in oven exo's in LA in
01:20:23around LA in Latino neighborhoods,
01:20:26but also in Oakland, CA and Redwood City.
01:20:30And these are nexos.
01:20:32Are different in the sense that
01:20:35they allow people to leave during
01:20:37the day in search of work.
01:20:40Not only to sort of give money to the
01:20:43sum of their earnings to the next,
01:20:47so for their upkeep,
01:20:48but also so that they can send money home,
01:20:52but they practice the 4th and 5th step.
01:20:55They forms of strict bodily
01:20:57comportment and verbal and physical.
01:21:02Say abuse and other practices within
01:21:04Mexico are also seen in the US,
01:21:07and there's also I wish I
01:21:10could have shown this slide.
01:21:12There's a yearly convention of
01:21:14padrinos every year in the United
01:21:17States an the couple of years ago I
01:21:21went to one that was in Palo Alto,
01:21:24which was like actually was
01:21:26Redwood City and people came
01:21:28all the way from Pennsylvania.
01:21:30Having taken the Greyhound bus.
01:21:32To get to the convention and they
01:21:35were sleeping on like the floors of
01:21:38hotels and the floors of families.
01:21:40In order to participate and part of that
01:21:43program was how to become a counselor,
01:21:46how to become adrenal.
01:21:47So in a sense this goes back to
01:21:50another question which was about
01:21:52what are people doing inside to
01:21:55kind of improve them and the yearly
01:21:57convention which is now in year 7.
01:22:02Last years was in Las Vegas is
01:22:05a space where you know, I mean,
01:22:08it's like sort of like an academic
01:22:11conference recessions where people
01:22:13kind of come together and talk
01:22:16about the difficulties,
01:22:18but also the possibilities of really creating
01:22:22a more sustainable kind of structure.
01:22:26And and that's really interesting.
01:22:28And most of those meetings that
01:22:31those conferences are filled with
01:22:34three nodes in Medina's from the US,
01:22:37and they always call a keynote speaker,
01:22:40and they're always from Mexico,
01:22:42and they tend to be the first
01:22:46few founders of Nexos.
01:22:49Mexico City Nexus were founded
01:22:52in Mexico City.
01:22:53And so those tend to be
01:22:56the keynote addresses.
01:22:57I've seen the same people over the past
01:22:59few years giving the initial address in
01:23:02there sort of treated like rockstars.
01:23:04You know there,
01:23:05or you know,
01:23:06they're they're very.
01:23:09You know they are what's the
01:23:12word I'm looking for.
01:23:13They they're really held in very high
01:23:16esteem and there's a clear desire amongst
01:23:19councils in Patrinos to become like them.
01:23:23Their role models essentially.
01:23:25And so becoming a counselor?
01:23:27Yeah,
01:23:28these are some of the things that are that
01:23:31are sort of discussed in in the conventions.
01:23:35But in Mexico specifically what
01:23:37I saw was it's it's partly about
01:23:40length of time within an exo.
01:23:42The desire to become a counselor.
01:23:45There are steps,
01:23:46there are different levels of counselors.
01:23:49One level is called the
01:23:51enforcer and they basically.
01:23:53Make sure people are maintaining
01:23:56composure and listening etc and they
01:23:59slowly work up the sort of chain.
01:24:02It's very hierarchical in structure
01:24:04and a lot of people an XL those
01:24:08desire at some point to become
01:24:10a passerino or Amanda MENA,
01:24:13and so those that do are often
01:24:17given the opportunity to do so
01:24:20if they are not a troublemaker.
01:24:23So so yeah,
01:24:24there is a structure for this to occur.
01:24:28Sorry my dog is scratching on the door.
01:24:33Her scratching it's my dog.
01:24:34This
01:24:35is what conferences are like now.
01:24:37For for us, thank you so much.
01:24:39One thing I wanted to express through
01:24:41the chat is just amount of gratitude
01:24:43that's coming in for the work that
01:24:46you've presented for the way that it
01:24:48challenged me as well as I think a lot
01:24:51of other people here to really think
01:24:53about what we mean by recovery and
01:24:56what that looks like and how it can
01:24:58look different in different places,
01:25:00but also how recovery in
01:25:02other places should challenge.
01:25:03Think about recovery here perhaps.
01:25:07And that's just one of the many rich
01:25:09lessons that you've offered us today.
01:25:11So just from everyone,
01:25:12thank you so so much for coming here,
01:25:15particularly at this early hour
01:25:17on the West Coast.
01:25:19The clap, we would all clap for you.
01:25:23Our virtual applause.
01:25:24I hope that comes through and I can't
01:25:26imagine a better way to have kicked
01:25:29off this series of website events.
01:25:31I've dropped everyone the registration link
01:25:33for the website events that are coming over
01:25:36the course of the next month and a half.
01:25:39Please register if you're interested,
01:25:41if they're even half as good as this keynote,
01:25:44I think that would be a lot to learn.
01:25:48Thank you everyone.
01:25:49I don't know if you have any other
01:25:51housekeeping Tricia, but deep gratitude.
01:25:53Professor Garcia. Thank you
01:25:55so much as a pleasure.
01:25:56Good way to start the day.
01:25:59So thank you for the invitation.
01:26:04OK, should I just sign up then?
01:26:07OK, thank you. Thank you.
01:26:09Thank you very much.