On a bright summer day in a sleepy park on Kyiv’s left bank, Mariya tells me that she is done. Done with the doctors. Done with the pills. Done spending every day shuttling herself between home and this place where she must come to receive methadone to manage her chronic opiate addiction. She wants to be free, to find a job, to begin living a normal life again. “What is socialization?” she asks rhetorically. “It is an infusion into society, right? So, if you work, you’ll have that means of attaching yourself to normal people. You won’t have to deal with this mess here, where there’s no one but addicts and medical personnel.” Unfortunately, the change that Mariya longs for is unlikely to come. Ukraine has undergone tumultuous socio-political transformations in the two and a half years since Mariya confessed her exhaustion. Ukrainians are forging visions of a freer, more democratic, more prosperous nation, and they are visions that do not include her.
In his book, Pharmaceutical Reason, Andrew Lakoff argued the diagnostic criteria for mental health disorders like bi-polar are boundary objects: objects that are known and shared across multiple discursive plains, yet are adaptable to the needs and ideologies of the diverse communities that engage them. Addiction is also a boundary object. The diagnostic criteria for the disorder—and the social norms against which those criteria are brought into relief—are variable across cultures, as is the social imagination of who addicts are, what is “wrong” with them, and how they should be managed.
In the United States, the term addict fills a contemporary “savage slot.” It is a signifier into which we have cast so many of our fears and judgments. As a class of individuals, so-called addicts are disparaged as dangerous figures who cannot be trusted, who generate social harm. They are called highly derogatory slurs (e.g., crack head, tweeker, junkie), which evoke our most racist and classist distinctions. Although drug use and dependence are worldwide phenomena, these culture-bound “addiction imaginaries” are fundamentally American.
In Ukraine, the “addiction imaginary” maps onto a different constellation of culture-bound anxieties. To borrow a term from Nikolas Rose, the concept of addiction in Ukraine articulates a potent “ethopolitics,” which discriminates between individuals according to their perceived mental freedom and their ability to be agents of their own will. Just as mainstream American culture values independence and self-reliance, Ukrainian culture holds up such willfulness and deliberate, sober self-determination as an ideal manifestation of the social self.
The EuroMaidan revolution was a potent site for the production of this form of citizenship and the maintenance of its social boundaries. For example, EuroMaidan’s opponents (i.e., government supporters) were often called “prostitutes” by EuroMaidan activists. They were accused of valuing monetary bribes (for participating in counter-protests) over their personal freedom. They were called “slaves,” chastised as overwhelmed by political forces and incapable of thinking for themselves. They were called “cattle,” “livestock,” “animals,” inhuman creatures incapable of free will.
The resonance of culture-bound “addiction imaginaries” with this discourse of citizenship is visible across Ukraine’s many conflicts. In 2014, the pro-Kremlin news agency Voice of Russia (now called Sputnik News) published accounts from Russians who claimed they were drugged by the food served at EuroMaidan in Kyiv. Ukrainians, it was implied, were only engaging in civil disobedience because they were quite literally out of their minds. Later that year, Ukrainian soldiers fighting near Donetsk reported that separatist blockades were littered with syringes. Russian military agents, they argued, were fueling the conflict by doping up local men and propping them against block posts with guns in their hands. “They don’t even feel it when they are shot and killed,” one soldier claimed.
Viewed through this ideological lens, those perceived to act without will, without agency, without free thought, are fundamentally dangerous. They are not subjects but puppets—spiritually empty vessels open to manipulation by powerful others with harmful intentions. People who use drugs, or who are receiving treatment for opiate dependence, are painted as outsiders, because addiction is believed to cause (and be caused by) a disconnect between one’s behavior and one’s inner will. (I describe this view in detail in a recent article in Transcultural Psychiatry.)
Despite its scientific inaccuracy, the circular logic that connects addiction to spiritual slavery is so compelling that it has become a central articulation through which visions of a new, independent, and more European Ukraine come into being. For many, a “European Ukraine” is characterized by higher wages, stronger individual freedoms, and greater government transparency. Unfortunately, however, people who use drugs—even those in recovery—are likely to face insurmountable difficulties in rehabilitating their social careers—even in a “European Ukraine”—so long as their outsider status remains a common-sense element of the social fabric.
“Is [offering medication-assisted therapy] profitable for our government? It is.” Maryia explained. “Not because the Global Fund pays for them, but because they want their citizens to be put on the right path. But it seems to me [they do it] only because they are getting paid, because they have to move closer to Europe, and if we didn’t have it, Europe would say ‘What kind of European country doesn’t have these programs?’” Mariya knows that her own freedom and social opportunities are, as much as anyone else’s, a measure of Ukraine’s success as a sovereign state. Yet, so long as Ukraine simply goes through the motions of affording drug users basic medical rights, their social rights are unlikely to follow. Instead, Mariya (and the 300,000 other Ukrainians whose lives are linked to drug use) will watch quietly from the edges as their country lays the groundwork for a better future that does not include them.
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Jennifer J. Carroll, Ph.D., M.P.H, is a Postdoctoral Fellow in the Division of Infectious Diseases at the Miriam Hospital in Providence, R.I. This essay is adapted from Carroll’s paper titled “To Live a Normal Life: Notes on Revolution, Collectivity, and Social Distinction in Ukraine,” which won the 2015 SAE Graduate Student Paper Prize and is currently in press at Critique & Humanism.
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