The Pastoral Clinic: Addiction and Dispossession along the Rio Grande

“But from my moment with John at the Rio Grande, I recognized that the two were inextricably linked. New Mexico’s landscape makes visible the existence of addiction, and addiction shapes and is shaped by New Mexico’s landscape. Each has its own processes of sedimentation.”

Garcia includes John’s story of visiting the Rio Grande to emphasize a major theme: The Connections Between Land, Loss, and Experience. She wonders whether John would have stayed at the clinic if the Rio Grande had been teeming with life. His declaration that “the river is dead” reminds Garcia that for residents of Española Valley, the destruction of the land around them is a continuous reminder of loss. Garcia argues that heroin addiction in the region and the history of New Mexico’s landscape are interconnected, each informing the other. Garcia creates a sense of intimacy in her writing through first-person pronouns and point of view, as well as using first names when discussing her subjects.

“Loss and mourning provide more than a metaphor for heroin addiction: they trace a kind of chronology, a temporality, of it. They even provide a constitutive power for it.”

Central to Garcia’s argument is that addiction does not exist in isolation. She suggests that addiction is part of an interlocking web of factors, including an overwhelming sense of loss. In the Introduction, she establishes the idea that loss creates a framework for addiction and continues to inform it over time.

“They were moments of rupture and of shared singularity. These were moments when I could imagine the possibility of a new kind of care.”

As Garcia reflects on her first night working at Nuevo Día, she realizes that caring for patients with heroin addiction requires more than medication and clinical treatment.