Saturday, May 25, 2013

Heroin users and the silence of shitting

***This post contains graphic content.***

Taking heroin makes you so constipated, it’s a nightmare…The heroin makes you constipated so you won’t go to the loo for a couple of weeks, two, three weeks. So then I’ll take, not a huge amount [of Epsom salts], but I always end up taking too much, but it does, it clears you out…Being constipated is quite nasty, and I mean horribly, horribly. It’s like bloody coal mining, the agony and the pain. Putting your bloody fingers up your bum to pull out bits of, like, fucking diamonds. It’s not nice, [it] really is not nice.

Neil sits at the table in his parents’ kitchen across from the interviewer. A freshly-washed suitcase dries out in the sun. Tomorrow, he’ll be leaving for three months of residential detox and rehabilitation for his heroin habit.


            In the April 2013 issue of Medical Anthropology: Cross-Cultural Studies in Health and Illness, Lucy Pickering, Joanne Neale, and Sarah Nettleton published “Recovering a Fecal Habitus: Analyzing Heroin Users’ Toilet Talk.” As part of their larger work on drug users, they found themselves talking to many of the heroin users about shitting—how agonizingly painful it is. Neil had been asked broadly about the physical effects of heroin, and instead of focusing on oblivion, sores, illness, drowsiness, contentment as many of the other users had done, he had focused on this: the painful betrayal of the body to do a basic function which Neil did not have to even think about before.
            We don’t talk about shitting very much. There is a silence around the topic. Even in Phillipe Bourgois and Jeffrey Schonberg’s book, Righteous Dopefiend, a profoundly beautiful and detailed ethnography about homeless heroin users in San Francisco, constipation caused by heroin use was never mentioned. The literature on shit is pretty sparse in comparison to just about every other topic. We don’t talk about our bodily functions with other people; it’s part of being in society.
When we’re little, we learn how to use the porcelain potty, and then once we have mastered that, we also master the silencing of discussing our bodily functions. This trajectory is a mirror image of the one that has happened in human history. Historically, shitting was a communal act (see Roman public toilets or English peasants). We could talk about it. But as history as progressed, the silence and the taboos around bodily acts—farting, blowing one’s nose, shitting—have increased. Furthermore, it became a function of class. The upper classes did not want to smell like the lower class; by suppressing their bodies, by asserting control over them, they asserted their supremacy. This goes all the way back to the Cartesian mind/body dualism issue—the idea that mind and body are separate. In that frame, mind is usually privileged over the body. Controlling one’s body shows one’s strength of mind.
            In the authors’ narrative about the heroin users, the users were more open about their defecating when their excretory systems began to malfunction from the drugs. (Opioids increase the amount of time stool takes to move through the gastric system by increasing nonpropulsive contractions in the middle of the intestine and decreasing propulsive peristalsis—in other words, they make the muscles that move things through your intestines mess up.) As the drug users became increasingly marginalized in society, they also stopped partaking in the silencing of their body functions.
            More plainly, marginalized people suddenly get to talk about marginalized things. To reverse the equation, people who talk about marginalized things become marginalized. (What would happen if you started talking about shitting all the time? …Exactly.)
            So what if people really need to talk about defecating? If we put so many layers of silence on top of defecation, how can people really get the help they need? This is true not only for heroin users, but what about patients who are using opioid-based medications? The elderly who have problems managing their defecation? It’s embarrassing to talk about. If people feel like they can’t ask for help, when they do, we marginalize already marginalized populations.
            Pickering, Neale, and Nettleton delve into this silence in an academic space with a marginalized, ‘othered’ population. It’s a place to start, but only start. There’s a lot more that needs to be done to eliminate this cultural silence so we can help people better manage their bodies and lives.

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