A review of The Sober Self: Discourse and Identity of Recovering Alcoholics in the Western Highlands of Guatemala, by Carla Pezzia.
“The Sober Self” draws upon long-term ethnographic fieldwork and epidemiological surveys to argue that prevailing public discourses and a narrow range of treatment options exacerbate problem drinking among indigenous men in Panajachel, Guatemala. Many anthropologists have argued that 12 step programs like Alcoholics Anonymous (AA) do not translate well to other cultural contexts, and Pezzia’s research confirms this finding. Nonetheless, policy makers continue to rely heavily on AA, a voluntary program that costs the state nothing, as the primary treatment option for alcoholism. Research on problem drinking in Latin America likewise tends to focus on AA. Another line of research points to the importance of conversion to evangelical Protestantism, which prohibits alcohol consumption, in recovery. Pezzia argues that in the context of Guatemala, neither AA nor evangelical churches alone provide adequate treatment options.
Her explanation of the limitations of these institutions uses a phenomenological framework that pivots on the difference between an externally imposed identity and an internally fostered sense of self. Proclaiming an alcoholic identity is the cornerstone of AA-style recovery. However, in Guatemala, where discrimination against indigenous people relies upon stereotypes of them as sub-human, dishonest drunks, proclaiming an alcoholic identity may in fact promote relapse. In contrast, the successful recoveries Pezzia documents among the Kaqchikel Maya men she interviews involve the development of a sober self, an internal experience of life with value and purpose, and not the external embrace of an alcoholic identity. Chapter 1 outlines this argument, elaborates the study methodology and positions this work as a contribution to the development of an ethically committed, critical medical anthropology.
Chapter 2 turns to the setting of the study. Panajachel is an ethnically mixed town with an economy organized around tourism and a significant expatriate population. As the gateway to Lake Atitlán, Panajachel ranks as the third most visited locale in Guatemala after Antigua and Tikal. Despite significant economic and population growth, few of the town’s Maya residents have benefited from development. Instead their experiences are characterized by insecurity and vulnerability to threats that range from crime and extortion to landslides during the rainy season. Pezzia argues that all of these “interrelated nodes of experience” contribute to problem drinking (p. 71).
Chapter 3 looks at Guatemala’s mental health care system at both the local and national levels. In this underfunded system, access to care is structured by access to capital. The one mental health hospital in the country has been accused of repeated human rights violations, while private drug rehabilitation facilities are not subject to government oversight. This chapter is largely based on the results of an epidemiological survey the author conducted, and centers on a comparison of local results to national findings. Residents of Panajachel report higher rates of mental illness than the national average, with high rates of suicidal ideation, where men report more problems than women. While local officials assume that indigenous Guatemalans are not interested in mental health services, Pezzia finds the opposite to be true.
Chapter 4 describes how alcoholism is intertwined with Guatemala’s history of racism and discrimination, elaborating the commonly held view that “drunkenness is innate to indigeneity” (108). Pezzia uses critical discourse analyses (CDA), as developed in the work of Norman Fairclough, to analyze interview data with former and current problem drinkers and health care providers. Alcoholics are repeatedly compared to dogs and trash, as well as accused of criminality. The stigma that continues to surround alcoholism means that scarce institutional resources are normally directed elsewhere. Pezzia concludes that ongoing public discourses hinder effective policy and make it harder for low-income indigenous problem drinkers to seek help.
In the fifth chapter, also entitled “The Sober Self,” Pezzia elaborates on Chapter 1’s argument about the limitations of extant recovery options through a close analysis of life history interviews that she conducted. Many find the terapia dura (tough love) of AA as practiced in Guatemala alienating, while others report that evangelical churches are unwelcoming to alcoholics. Several of the AA participants she interviewed relapsed during the course of her study. Instead, “natural recovery,” in which individuals develop a “sober self” on their own without any formalized treatment emerges as one of the primary avenues of recovery for the indigenous men interviewed.
Chapter 6 concludes by focusing on the need to alter public discourse in Guatemala that maintains that drunks are untrustworthy and non-productive. She notes that the majority of the people interviewed expressed a desire to open a rehabilitation center that would be a place of compassion rather than condemnation.
As a work of ethnography, the dissertation primarily draws upon the author’s ethnographic fieldwork, specifically field notes recording participant observation, life histories, and semi-structured interviews with recovering alcoholics, health care providers and other community members. This work is supplemented by an epidemiological survey the author conducted, which forms the basis for much of the information in chapter three. Life histories conducted with former and current problem drinkers form the crux of chapter five, which contains the heart of the argument about the gap between embracing an alcoholic identity and fostering a sober self.
This primary data is in conversation with several strands of anthropological literature. The most important of these is the tradition of critical medical anthropology as espoused by Paul Farmer and Philippe Bourgois, which overlaps with the commitments of the activist anthropology outlined by Charles Hale. Another thread is the intersection of medical anthropology with phenomenology, most often discussed in this work with reference to Biehl and Locke’s influential article on becoming. Finally, this work is in conversation with ethnographers who have conducted work on drug and alcohol recovery in non-western contexts who have made similar observations about the limits of the culturally-specific AA model, including Brady, Spicer and Zigon.
This dissertation is a solidly researched contribution to both critical medical anthropology and activist anthropology. It includes an applied component—offering specific policy recommendations for the improvement of treatment options among excluded indigenous populations in Guatemala. Beyond these specific recommendations, this work provides a thoughtful theoretical consideration of the interplay between stigma, identity, self and possible selves in recovery from addiction.
Department of Anthropology
University of California, Los Angeles
Participant observation, life histories, semi-structured interviews with recovering alcoholics, health care providers and other community members in Panajachel, Guatemala.
The University of Texas at San Antonio. 2013. 233 pp. Primary Advisor: K. Jill Fleuriet.
Image: Donde Lloran Los Valientes by Antonio Coche Mendoza, a Tz’utujil Maya artist from San Juan La Laguna, made in 2007. Personal collection of Carla Pezzia. Photograph by Tim Wallace.