INTRODUCTION
Setting speakers and sitting secrets
In September 1995, upon obtaining a $3 million grant from the National Office of Housing and Urban Design (HUD), five nonprofit social service agencies in a Midwestern city banded together to establish an array of programs for local homeless women and their children. Titled the “Homeless Family Consortium” (HFC), this collaborative venture was inspired by local social workers' consensus that homeless mothers had been abandoned by the area's social service networks, particularly in regard to drug treatment. Thus, HFC designated a large portion of the garnered grant funds to Fresh Beginnings, an intensive outpatient program designed specifically for the treatment of drug-using homeless women.1
There are four levels of drug treatment set by the ASAM-PPC-2, a standardized tool for placing people in treatment according to the intensity of services. Intensive Outpatient Programs (IOPs) are considered, along with partial hospitalization, a Level II service and require clients to attend treatment at least three days a week. Changes in the U.S. healthcare system in the 1980s and 1990s, particularly in regard to managed care, have severely restricted the length of stay in inpatient services.
From its inception, Fresh Beginnings defined itself against “traditional” treatment programs that were thought incapable of sensitively treating homeless women. Administrators asserted that whereas traditional drug treatment approached clients as unqualified addicts with homogeneous needs, their innovative program would recognize that homeless women addicts had special needs that could be answered only with correspondingly specialized services. Although all involved in the founding of the program insisted that Fresh Beginnings would be different in both its clinical orientation and its program design, like those of many other American treatment facilities its therapeutic regimen relied heavily on the 12-step model.2
The twelve steps, guiding statements meant to lead to sobriety, were created by the founders of Alcoholics Anonymous and adopted by an ever-expanding array of “step” programs (Narcotics Anonymous, Cocaine Anonymous, Overeaters Anonymous, Gamblers Anonymous, etc.). The National Treatment Center Summary Report, which surveyed over 450 treatment programs in 1997, estimates that more than 93% of drug treatment programs are 12-step programs (Roman & Blum 2002; see also Nelson Woods 1995, Lemanski 2001). However, as argued by Wallace 1996 and demonstrated by Durkin 2002, formal programs “relax” some of AA's “self-help” ideals and adapt the steps in line with their own existing practices and protocols (see also Hasenfeld & Gidron 1993).
The young Fresh Beginnings program also lauded its ability to address homeless mothers' special needs through a system of coordinated care. Each client met regularly with her designated HFC case manager, whose role it was to address pragmatic issues related to housing, employment, or education, as well as with a clinical team comprised of family counselors and drug treatment therapists. Fresh Beginnings also provided an array of support services, such as childcare and transportation, which other local treatment programs lacked. With two drug treatment therapists, two family therapists, three van drivers, a part-time childcare staff, and a cadre of volunteers, the program was designed to accommodate ten to twelve families at a time. However, on most mornings only five or six clients arrived by the white program van at the Fresh Beginnings building on Cliff Street, each with a determination to meet HFC agency or parole requirements and some with an investment in eliminating a drug habit.
Regardless of their individual inclination toward the program's stated goals of “sobriety and self-sufficiency,” Fresh Beginnings clients shared similar practical stakes in moving swiftly through treatment. The vast majority of incoming clients did not attend the program voluntarily. Instead, the various social service and penal systems with which they were involved had rendered the custody of their children, their continued parole, and/or their subsidized housing and shelter contingent on the successful completion of treatment. Notably, therapists evaluated clients' relative therapeutic progress largely according to how those clients represented themselves and their problems in language. Indeed, at Fresh Beginnings, one's success in treatment was tied to one's adoption of and adherence to a very particular way of speaking – a fact hardly lost on the women who attended the program.
Arming themselves with mugs of instant coffee, pastel tissue boxes, and Alcoholics Anonymous pamphlets, arriving clients settled into donated couches arranged around a swiveling office chair. As the therapist took that central seat, the unpredictable cadence of multidirectional banter, hushed sympathies about lovers or johns, and the occasional exasperated guffaw segued quickly into the daily regimen of group therapy. Fresh Beginnings clients took turns weaving the morning's designated theme (e.g., shame, codependency, responsibility) into predictable narratives of early trauma, accelerated denial, rock bottom, and willful recovery, as an attentive therapist looked on.
Method, metalinguistics, and the production of inner reference
As a neophyte social worker, attempting to establish formal organizational mechanisms for clients to participate in program development and give feedback to professional staff, I soon realized that Fresh Beginnings' therapeutic regimen was predicated on talk. Waiting outside the closed door of the group therapy room, where I convened the weekly Client Advisory Committee meetings, I listened to the muffled cadence of therapy sessions that lasted as long as three hours. On other days, I smoked cigarettes with clients on the building's front porch, where therapeutic talk frequently spilled over, often in the form of critical commentary. And while I generally steered clear of group therapy, I regularly attended “special” sessions that celebrated a client's sobriety anniversary, birthday, or advancement to the next treatment phase. Even more frequently, I found myself witness to impromptu therapeutic exchanges between therapists and clients – clients who spent the majority of their waking weekdays talking about themselves at Cliff Street.
Such loquacity is a common feature of contemporary American drug treatment. Whether one enters a clinician-led group therapy session within the formal treatment system (which consists of approximately 10,000 federal, state, and local programs that see about 1.8 million clients annually),3
Owing to a number of factors, including the large number of quasi-formal treatment systems, the line between “formal” and “self-help” is hard to draw. The estimates of the size and population of the formal treatment system provided here are taken from the National Institute of Drug Abuse's 1993 Treatment Unit survey.
While the sheer volume of such clinically guided talk was readily evident from my vantage point as a client organizer, it was not until I began to study Fresh Beginnings as an anthropologist that I realized that the program also played host to a tremendous amount of talk about talk. In the group therapy room, around the staff table, and in a multitude of conversations with clients, other professionals, and a curious social worker-cum-anthropologist,4
I collected the data that serve as the basis of this essay through the following means: formal interviews with Fresh Beginnings clients, staff, administrators, and other program affiliates (all of which were tape recorded and transcribed); group interviews with clients and staff; countless hours over a three-year period of participant observation, including the observation of “natural occurring discourse” (the majority of which was not recorded); and systematic review of treatment guides, manuals, and other program documents. Additionally, some program staff and clients granted me access to written and electronic correspondence such as those utilized in the last section of the discussion.
According to the ideology of inner reference, language works when the radical split between signified and signifier is bridged by the process of signification as the speaker chooses the words that correspond to discrete, preexistent inner referents.5
Seeking the kind of transparency that comes with a “perfect match” between spoken signifier and stored signified, the ideology of inner reference is consistent with the norm of sincerity of speech, as Keane describes it: “The concept of sincerity … seems to assume a clear distinction between words and thought, as parallel discourses (interior and exterior) such that they either could or could not match up. Should they indeed match up, language would thereby become transparent, nothing significant would remain of the material forms or social origins of words, allowing the unmediated thought to reveal itself. Moreover, as a linguistic ideology, the concept of sincerity also seeks the authority of words in that relationship of matching” (2002:72).
Rather than taking reference and performance as polar extremes and assigning pragmatic efficacy only to the latter, Silverstein 2004 demonstrates the utility of seeing reference as central to a speech act's ability to perform or produce (see also Reddy 2001:97–98). Although this essay will not explore this semiotic relationship in depth, suffice it to say that at Fresh Beginnings, the instrumentality of a speech act (in healing) was ideologically dependent on its referentiality.
Some organizational theorists have argued that institutions are cultures with languages and ideologies of their own; however, the ideology of inner reference was neither the exclusive province of the Fresh Beginnings program nor the invention of the therapists whose metalinguistic claims so clearly articulated it. The ideology of reference, which works to confine language's function to the reference of preexisting people, ideas, and things, is the dominant language ideology of Euro-Americans (Silverstein 1979, 1981, 1985; Irvine 1989, Woolard 1998, Kroskrity 2000). Arguably, the ideology of inner reference, which further limits the reach of words to the contents of individual psyches, is one that enjoys broad cultural circulation in the contemporary United States. Talk show confessionals, tell-all memoirs, and the sheer pervasiveness of what James Wilce (1998:51) aptly calls “I talk” are compelling evidence that language is widely thought to be a reflection of inner being rather than a manifestation of situated sociality.
A number of scholars have shown that referential language enjoys particular currency in clinical settings and situations. For example, in his ethnography of a Boston homeless shelter where many residents had been diagnosed with mental illnesses, Robert Desjarlais notes that “the staff advanced a way of thinking about language that came close to an ideology dominant in many contemporary English-speaking societies which gives priority to the referential, semantic, and propositional functions of language” (1997:180). In his discussions of the poetics of madness in rural Bangladesh, Wilce (1998, 2004) demonstrates that “sane” others reject linguistic performances that do not accurately denote nonlinguistic facts, especially longed-for “facts” about otherwise puzzling inner states. Allan Young's fascinating study of a psychiatric unit for Vietnam veterans highlights both the clinical demand for patients to verbally disclose the “contents” of their trauma-laden memory and the punitive measures reserved for those who do not engage in the work of authentic linguistic representation (1995:214–16). And, of course, in tracing the use of confessional techniques from the early church to the contemporary clinic, Michel Foucault (e.g., 1978, 1988, 1993) established the complicity of referential language in the very making of the modern subject.
Yet although Fresh Beginnings' language ideology was shared with its cultural and clinical surrounds, the young program was dedicated to its perfection in practice. Indeed, in making metalinguistic claims, therapists did not simply articulate the ideological premises of inner reference but mobilized those premises as a clinical regimen. Programs like Fresh Beginnings have indeed inherited, ready-made, the idea that “healthy” language functions to denote preexisting psychic and social facts, but the ethnographic observer of American drug treatment cannot help but be struck by the amount of work it takes to guard, protect, and patrol these highly naturalized assumptions. I call such work metalinguistic labor, arguing that while therapeutic interventions seemed to elicit inner signs that were always already there, awaiting cathartic escape in language, Fresh Beginnings therapy was instead an exercise in linguistic production that required the labor of therapists, the compliance of clients, and the use of particular metalinguistic tools for producing a perfectly transparent language.
Relying largely on data gleaned from extensive interviews with program clients and staff, this essay focuses on one such metalinguistic tool: the frequently evoked acronym “HOW” (Honesty, Openness, Willingness), which therapists used to guide and sanction their clients' talk. As both therapists and clients attest in the excerpts below, “Honest, Open and Willing” talk involved the revelation of particular content: the sins of the past and the residual shame of the present recounted in linear plotlines aimed toward willful recovery. Yet HOW was also a particular method of speaking, a method that worked to minimize the potential of words to point, protest, or critique rather than merely self-refer. Institutions transmit ideas regarding both discursive content and discursive method (Silverstein & Urban 1996), and although therapists claimed that the contents of clients' consciences, as inner signs to be spoken, demanded particular methods of speaking, it is also certain that the methods of speaking they prescribed elicited particular content.
If Fresh Beginnings was interested in perfecting the language of inner reference and in socializing7
At Fresh Beginnings, metalinguistic labor – speakers' explicit claims about what good or healthy language is and the activation of those claims in clinical practice – played a central role in language socialization. Here, I take language socialization to be a lifelong process in and by which individual speakers are introduced to new cultural settings, such as institutions, that require them to use and understand language in new ways (Duranti 1997). While the term “socialization” can connote a benign developmental process, a number of analysts have shown that language socialization is highly ideological and power-laden. For example, Bourdieu 1991 argues that by routinizing participation in linguistic events, language socialization aligns unconscious dispositions with ideological premises.
In lining up therapists' actions with an ideology of language, I risk portraying them as dupes of political processes that I myself am somehow beyond, having analyzed (and thereby resisted) them (see Bauman & Briggs 2003). However, linguistic analysis demands that we always situate speech acts – including metalinguistic claims – within their spatiotemporal context, considering the shifting positions of speakers and the stake-filled histories of their speech. It is therefore important to keep in mind that Fresh Beginnings therapists are simply working to be “good therapists” within a disciplinary, institutional, and cultural context that has already defined what that means. (I, on the other hand, am trying to be a “good anthropologist” and a “good client organizer,” worrying about the political effects of clinical practices.) Thus, our best question might not be “Why did the therapist do/say that?” but instead, “What else can she, in that time and place, (felicitously) say or do?” My thanks to Janet Hart, Webb Keane, and James Wilce for their encouragement explicitly to address this issue, which I have pursued at greater length elsewhere.
THE IMPORTANCE OF SPEAKING SUBSTANCE
Addiction, denial, simulacrum
Local regimes of personhood select some speech acts as exemplary of “healthy” human agency (Hill 2000:261). These select speech acts are grounded in local language ideologies that implicitly inform speakers of just what their words can (legitimately) say and do. To be a “healthy” Western individual, one must use words that do little but transparently reflect one's own “realities.” It is not surprising, then, that the ideology of inner reference would enjoy even greater currency in the treatment of addicts who – according to both clinical and cultural judgment – have very tenuous ties with reality.9
As Derrida effectively argues, the addict is considered problematic precisely because she cuts ties with the world and escapes into simulacrum: “We do not object to the drug user's pleasure per se, but to a pleasure taken in an experience without truth” (1993:236). In opposition to the Platonic subject who gains his authenticity through his productive interactions in the life of the community, the drug addict “produces nothing, nothing true or real” (1993:236) and instead takes in, injects, and inhales, epitomizing the unproductive citizen. Thus, if drug addiction involves succumbing to an alternate reality and losing touch with one's self, drug treatment must draw the addict back into the realities of modern productive, healthy, and individuated selfhood.
Although increasingly challenged by feminist and constructivist drug treatment scholars,10
Reed 1985 posits that women suffer less than men from denial, and many gender-sensitive programs have taken this proposition into account. For example, Women for Sobriety (WFS), a women-centered self-help alternative to AA, suggests that addiction is a matter of “faulty thinking” rather than denial (see Kaskutas 1989, 1992). Feminist scholars such as Berenson 1991, Haaken 1993, Kaskutas 1989, Nelson-Zlupko et al. 1995 also fundamentally, if not always explicitly, challenge the notion of denial by focusing on the sociological correlates of addiction. On the other hand, feminists such as Cook 1995 and Hendrickson 1992 evidence the ways in which the tropes of cultural feminism can sometimes dovetail with current treatment ideas about denial. For example, Cook 1995 employs a cultural feminist analysis to suggest that addicted women cannot rely on themselves to “know.” Constructivist contributions to drug treatment also, often implicitly, challenge the premise of denial (e.g., Bateson 1971, Fingarette 1988, Cain 1991, Lemanski 2001).
Since addiction is widely considered a progressive disease in which casual use develops into physical and/or psychological dependency, the symptoms of denial follow suit. Indeed, the drug-induced simulacrum soon proves to be sticky, as the addict comes to deny her history, her disease, and, inevitably, her very self (White 1998, McDowell & Spitz 1999:121). Addicted denial is at its most pernicious when the denying addict refuses to see the obvious truth about herself: that she is an addict. At this stage, treatment is required in order to dismantle the addict's denial by confronting her with the reality of her progressive disease (Kearney 1996, Lemanski 2001). In this sense, recovery is not simply a matter of quitting drugs, as the common therapeutic term “dry drunk” suggests.11
A “dry drunk” is one who continues to behave like an addict – for example, denying her problems and shirking responsibility for them – while having discontinued actual alcohol or drug use.
So if addiction and denial are regarded as a matter of eluding internal realities in favor of blaming external ones, it is no surprise that the language of drug treatment is so inwardly focused. One might argue that talk therapy is a discipline that teaches clients to exchange the consumption of illegal substances for the ejection of linguistic substance, and in so doing, to trade simulacrum and denial for honesty and truth. Indeed, the discussion that follows shows how Fresh Beginnings therapists worked to help clients articulate the realities that they presumably once denied. However, it will be evident that “denial” is also a feature of clinical interactions and institutional relations in which the clinicians' truths enjoy automatic precedence over those of their clients.
“Secrets keep you sick”
Convinced that a client's verbal self-representations could circumvent her addicted will, program therapists agreed that denial was their greatest clinical challenge. Treatment literature at the program, distributed to affiliated staff and posted on bulletin boards at Cliff Street, admonished that “we must remember that denial is a major barrier to recovery.” Clients, too, were regularly warned of the dangers of denial as therapists repeated the phrase “Secrets keep you sick” like a mantra.
At Fresh Beginnings, the “secret” was loaded with double entendre. Secrets left unrevealed were virulent because, much like Catholic confession, the naming of sins to an authorized audience was thought to heal the sinner.12
Indeed, while confession seems simply to refer to the sins of the sinner and, in this sense, is an exemplary ideological instance of inner reference, it is precisely because it refers that it so dramatically transforms (Carr n.d.).
Strategically shifting from a seemingly impersonal statement of clinical fact (line 1) to a client animator who provides supportive evidence (line 3), Susan suggests that as an unwilling prevaricator, the denying addict exercises uncanny linguistic control that could enable her to pass a polygraph test with ease (line 9). However, Susan goes on to explain that the denier passes not because she exercises linguistic agency but precisely because she lacks it entirely, keeping her unnamed secrets from herself (line 7) as well as the truth-seeking therapist (line 10).
It seems that the unflinching body and the unyielding words of the denying addict would pose an insurmountable challenge to therapists charged with reading their clients for signs of addiction. However, in an interview with the therapist Laura, I learned that the concept of denial aided rather hindered therapists in their efforts to line up clients' words with inner truths:
Laura, like her colleague Susan, takes pains to differentiate lies and pretenses (line 7) from denial (line 1). However, Laura's denier seems to tick to a more agentive clock, awaiting a safe time (line 8) to recognize and release the shameful referents of her memory. It is also notable that Laura conflates remembering (line 5) and admitting (line 4) as if there were no legitimate intervening variables between the two. According to Laura, when in the “safe” surrounds of treatment, the stuff (line 10) stored in clients' memories would not just start coming back (line 9), but would also, and seemingly automatically, start coming out in words.13
Silverstein & Urban 1996 propose that ritualization is a transaction between entextualization (the making of relatively stable, presupposable texts) and contextualization, and the accommodation of those texts to a particular spatiotemporal environ. In this passage, we can see that the contextualization of clients' speech (in the therapy room, for example) was dependent on a prior process of iconicization that had already rendered signs to be spoken as properties internal to the speaker. Indeed, thanks to a semiotic process by which the indexical features of a speech act are reduced to a presupposed and re-supposed (or reified) “here and now” (see Silverstein 2004), Laura can assert that the “stuff” of memory “comes back” to the client speaker and simply “comes out” in words. (An alternative metalinguistic claim might be that clients' elicited admissions produced particular kinds of “memories” that indexed cultural and clinical conventions, particular institutional demands, etc. – a claim that would clearly trouble the ideological premises of inner reference.)
Laura is also quick to acknowledge the great risks involved in remembering and admitting (line 4). Yet in casting drug treatment as a kind of temporal shelter for progressive remembering, she fails to address the most formidable risk facing her clients: that the unacceptable (line 2) contents of their admissions were regularly passed along in therapists' reports to the parole officers, Child Protective Service (CPS) workers, and HFC case managers to whom all Fresh Beginnings clients were also subject. For example, a client who spoke of a recent relapse could expect her words to travel outside the “safe” bounds of group therapy to the ears of a CPS worker with authority to take her children into state custody.
Of course, many clients were cognizant of these risks and worked to edit their responses accordingly. However, if therapists detected such editorializing, they might well charge their clients with “compliance” – a sign of continued addiction.14
“Compliance,” a clinical term popularized by the psychiatrist Harry Tiebout, an early avid supporter of AA, denotes a linguistic proclivity considered to be both specific to and rampant among addicts: the tendency to produce utterances devoid of the referential content that they effectively proclaim.
Yet if Laura's denier temporarily forgets the unacceptable acts she has shoved back in her mind, away from the signs that would betray them, Laura herself never doubts their existence; she waits patiently for the something (line 1), the it (line 8), the this (line 7) to be released into words. Here we have a clear illustration of the familiar Foucauldian assertion that the thrust of modern clinical authority is decidedly hermeneutic. Indeed, Laura's job here is not to judge her client (as we see, the client has already done that work, again in good Foucauldian form). Instead, Laura's job is to keep her analytical eye focused on the hidden, silent referent, ensuring that even though her clients' words may be false, they are never, ever empty.
HOW WE RECOVER: HONESTY, OPENNESS, WILLINGNESS
Letting it all hang out
Because therapists were ultimately unable to verify the constative value of the contents of clients' narratives, believed to lie deep in their denial-prone psyches, they focused their efforts on promoting honest methods of speaking, proposing an explicit set of tenets for clean and healthy talk. Most prominently, the acronym HOW (Honesty, Openness, and Willingness) linked honesty as an ideal with a particular form of outward expression. Indeed, therapists relied on HOW as a metalinguistic baton with which to guide their clients' talk.
In the hallways, offices, and therapy rooms at Cliff Street, therapists evoked HOW like a mantra, encouraging clients to use it as a semiotic token of recovery. During group therapy, Laura rewarded successful clients with “Certificates of Achievement” that read, for example, “For [Esther Smith] who is making a stronger commitment to her recovery, by demonstrating greater HOW (Honesty, Openness, and Willingness), and for working to raise her awareness.” After the award ceremony, when I asked Esther why she received this particular recognition, she responded accordingly: “I tell it like it is, baby, I let it all hang out.” Since, in line with Fresh Beginnings' language ideology, “honest” words were those that neatly corresponded with inner referents, one could simply “tell it like it is” if one was both open and willing to “let it all hang out.”
However, the practice of HOW was neither as straightforward nor as easy as Esther suggests, and therefore it merits further analytic attention. First, the question of how the acronym linked honesty and openness must be addressed. As Esther indicated, to be honest at Fresh Beginnings was to be open about what was (thought to be) “inside” – that is, one's feelings, memories, experiences, and desires. If honesty was a goal to be achieved, openness was the means of access. And openness was explicitly linked to articulation, inasmuch as one “opened oneself” to the extent that one opened one's mouth. As one former client, Keandra, offered: “Um, they helped me out a lot with opening up, because I was never one to verbalize a lot of things.”
Many clients, like Keandra, ostensibly agreed with their therapists that letting the “things” inside out in words was necessary if one hoped to recover from drug addiction.15
While HOW, as a pithy maxim, neatly consolidated a set of complicated and highly disciplined rules about how Fresh Beginnings clients should talk, it could not account for the multitudinous ways in which clients actually used language in practice. As Wittgenstein 1953 proposed, learning how to use a language is a lot like learning how to play a game. At Fresh Beginnings, the rules of the language game were established by the ideology of inner reference, and client players soon learned that the only “moves” they could legally make, or statements they could legitimately utter, were ones that abided by the rules of inner reference. However, as clients were consistently confronted with the limits of the “moves” their words could make at Fresh Beginnings, some began to question the nature of the game. Thus, just like chess players who anticipate their opponents' moves and maneuver accordingly, some clients developed a linguistic strategy to trump their therapist opponents. As client players practiced the game of inner reference, they not only learned to read and anticipate their opponents' moves, telling them what they wanted or expected to hear; some clients also began to decipher and ultimately learned to circumvent the rules of inner reference. Elsewhere (Carr in preparation) I describe the conditions under which clients learned how to engage in such linguistic ingenuity, and while this essay focuses on linguistic constraints, recognition of such strategic ingenuity is essential to fully understanding the individual voice in language (see Johnstone 2000).
Equating talking with “opening up,” Tealie suggests that while “open” talk has palliative powers, these can only be realized to the extent that words share the problems already inside her (line 1). She further laments, along with her therapist (line 4), that as long as her problems remain as signifieds without signs, she cannot realize the honesty needed for recovery.
However, despite her seeming adherence to a referential premise in which her problems (line 2) preexist their linguistic formulation, Tealie also indicates an awareness that her need to open up related to an institutional need to track clients' therapeutic progress (line 4). After all, openness not only helped clients feel better about themselves but also purportedly allowed therapists access to their problems. Notably, some Fresh Beginnings clients objected to this seeming intrusion.
Louise's philosophy
As the acronym HOW implies, in order to be open one had to be willing as well, and some clients, especially as they first began to attend group therapy, were disinclined to offer themselves up to their therapists' and peers' evaluations. One such client, Louise, explained:
Here Louise explains her initial trouble at Fresh Beginnings in terms of her unwillingness to be open (lines 4–5) about whatever was on [her] mind (line 1). However, in Louise's statement that unwillingness was her philosophy (line 8), she seems to recognize HOW as an ideological construct against which she philosophically stakes herself. Furthermore, Louise's commentary challenges the ideology of inner reference by pointing to the interactional and spatiotemporal indices of honest, open, willing talk (e.g., why are they tellin' these people all their business?). In this regard, her seemingly convoluted statement that she was not willing to be … honest, open, and willing (lines 4–5) makes a good deal of sense.
The expenditure of energy that such philosophical opposition required reportedly made it a very long day (line 4) for Louise as she sat silently through group therapy. However, it seems that the ideology of inner reference proved a tenacious institutional pull. Describing how she eventually came to participate in group therapy, Louise added:
Interestingly, Louise's acknowledgment of the troubling interactions of group therapy seemingly dissolves as she now describes the group as an open venue for her contributions (line 10). And while Louise explains her newfound willingness in terms of her own ability to relax and get into it (line 9), we might wonder how it is that the linguistic practices that she once found intrusive eventually “got into” her.
As we see above, HOW was a way of denoting highly interactive linguistic exchanges that characterized group therapy in distinctly intrapsychic terms. In the end, Louise, along with her therapists, cast talk as a transparent medium of self-revelation rather than a strategic kind of social action. And while Louise's final statement implies that her openness welled up from inside, her laughter (lines 10, 11) may indicate recognition that Fresh Beginnings had no interest whatsoever in shutting her up (line 11).
The lexicon of Lila's love life
Although HOW delineated the prerequisites of truthful talk at Fresh Beginnings, the tenet of willingness remained a tricky one. As demonstrated above, HOW worked to open the client's will so that she could self-refer. Yet the very activation of the addicted will involved the inherent risk that it would be put to nonreferential tasks. For example, particularly seasoned clients practiced the art of what they called “flipping the script,”—that is, spinning a convincingly personalized narrative of willful recovery so as to camouflage a recent relapse or obscure a weekend binge from program staff. While therapists employed HOW in the positive as a metalinguistic guide to truthful talk, they also used the acronym as an admonishment to those whose will had gone astray. The case of Lila, a client who voluntarily left the program after a series of problematic interactions with her therapist,16
As previously noted, because clients' success in the program was so often linked with their housing, their parole requirements, and/or custody of their children, very few clients who were in good status left Fresh Beginnings voluntarily. As far as I know, there were only three such cases (including Lila) among the more than 50 clients who filtered through the program during the course of this study.
I pieced together the story of how Lila left the program from a number of sources, including interviews with and documents written by Lila, Laura, and Lila's case manager.17
Revelant data were obtained from both Lila and Laura. In addition to the letters that Laura wrote Lila, I obtained a written exchange from Lila's case manager, who objected to Laura's handling of the case and filed a formal grievance, and Laura's ten-page response to her supervisors. Both documents (which Laura gave to me after she left the program) included verbatim transcriptions of relevant verbal exchanges between the two parties. In fact, the case manager's grievance included a two-page transcription of a message that Laura had left on her voicemail. In her grievance, the case manager's report of Laura's speech was damning, needing little coterminous commentary, and Laura was eventually disciplined by her supervisor for breach of client confidentiality.
In group, therapists greeted Lila's narrative with the usual array of gentle prompts, but they eventually homed in on the gender identity of the plural-pronouned “friend.” In response, Lila persisted that the gender of her companion was irrelevant since she was more concerned with sorting through the causes of her loneliness than with detailing the incidental relief offered by her comforting friend. Days later, during their regularly scheduled individual session, Laura proposed an analytical link between Lila's use of the third person plural pronoun and stalled progress in recovery, grounding both in Lila's “unwillingness to be honest.” In a later report to her supervisor, Laura wrote:
Laura's report readily highlights the analytical challenge posed by Lila's pronominal usage. As an absent referent that refuses the therapeutic present, Lila's they also refuses to be a ready-made indexical icon of inwardness – regardless of her intention in using it. Working within an ideological frame that insists on therapeutic reference, Laura must not only work to fill the semantic absence posed by the gender-neutral pronoun, glossing a spoken they as a real she; she must also make present what has been left performatively absent in Lila's speech act: a deictic nomination of herself as a lesbian.
Yet if Laura's letter lays out her dilemma, it also gives some sense of the very troubling solution. Here Lila's ambiguous plural pronoun, put in analytical interplay with a patently false male pronoun, is effectively rendered both a willful attempt to hide a real referent (line 1) and a “sick secret” (line 3).18
A similar linguistic bind is described by Young 1995 in his study of a specialized psychiatric unit for Vietnam veterans. In group therapy, patients' linguistic and paralinguistic behaviors are analytically funneled into categories of flaunted secret and healthy disclosure, though “stress reaction” rather than “denial” acts as the funneling modality.
In response to her therapist's tenacious assertions, Lila maintained that her love life was her “private business”19
Lila's use of the term “business” may be of some significance. In contrast to Laura's categorization of sexuality as a state, Lila (who had been romantically involved with both men and women) portrays her sexual life as a matter of practice and desire, both of which are decidedly private. This epistemological difference inflected the ongoing conflict, as Laura accused Lila of “shame” about “who she was” and Lila responded with surprise at what she saw as Laura's voyeurism into her “private business.”
After expressing her initial shock (characterized in line 5 as a “freak-out”) at such collective speculation in relation to pronomial usage, Lila eventually “slipped”20
Such “slips” pose an analytical challenge, burdened as they are by Freudian presumptions of deep desire finding linguistic escape on the one hand, and the reification of intentional language choice as exemplary of human consciousness in action. Moving beyond this dichotomy, Jane Hill builds on Goffman 1978 to suggest that dysfluencies do not emanate from a Freudian unconscious or an authentic, buried self. To the contrary, “the self which produces these is a responsible self which attends to precise representation” (Hill 1995:135).
Soon after this harrowing therapy session, Lila learned that Laura divulged to her case manager the contents of their therapy session, a move that she interpreted as both a violation of her privacy and explicitly counter to the program's confidentiality policies. Lila also began to suspect, rightly, that Laura had tricked her into identifying the gender identity of her friend. One week later, Lila made an appointment to tell Laura of her anger and disillusionment, which had culminated in a decision to leave the Fresh Beginnings program. At the meeting, Laura unsuccessfully attempted to dissuade Lila from transferring to a new program, but purportedly secured an agreement that Lila come to group one last time to tell members of her impending departure. When Lila did not show at the next group session, Laura sent a letter that included the following statements:
Notably, at this point Lila can neither be accused of dishonesty regarding her drug use nor reprimanded for her failure to disclose the gender of her friend. Instead, Lila is admonished for her infelicitous promise to bid formal farewell to her fellow group members (line 1–2). Even after Lila's case manager filed a grievance, which detailed Laura's own less than honest tactics, Laura's assertion that her client was guilty of failed honesty, openness, and willingness continued, not without irony. In her letter to Lila, Laura went so far as to write, “For you to decide to transfer to another program at this time suggests to me that you have relapsed and do not want others to know.”
Such a statement, of course, both circumvents Lila's expressed rationales for leaving the program and obscures Laura's culpability in precipitating her departure. Laura further insulates her analysis by suggesting that Lila be more open about how she is really feeling (line 4). Although Lila had been both loquacious and eloquent in expressing anger in relation to her therapist's actions, by qualifying Lila's feelings with the word really Laura implies that there is something spurious in her client's angry explanations.21
Notably, at Fresh Beginnings, anger was considered both endemic to addicts and a false emotion that covered up the “real” feelings that are denied in active addiction. Against the backdrop of denial, this view of anger helps both to cast Lila's rationales for leaving the program as evidence of continued addiction and discursively to erase Laura's actions from the scene.
Laura's work in keying (Goffman 1974) her client's troubling words and actions in line with the “healthy” premises of inner reference is clearly aided by the metalinguistic tool HOW. In Laura's letter, Lila is not just encouraged to be more open with her feelings, but is explicitly urged to honestly and willingly verbalize those feelings to her new therapist. Significantly, the metalanguage of HOW effectively streamlines the identification of feelings (line 4) and the articulation of needs directly to a therapist (line 3), as if there were no intervening variables between the two. Laura is thereby able to signify Lila's expressed lack of trust as a trait that belongs to a still unhealthy client, rather than as an emanation of their disturbing interaction. Thus, when Laura writes The only way we recover is through ‘Honesty, Openness and Willingness (HOW).’ It is now clear that this is very difficult for you” (lines 5–6), she effectively funnels a host of interactional dynamics into a failed, unrecovered you (lines 1, 2, 3, 4, 6).
Laura's analysis not only erases critical interactional dynamics22
Irvine & Gal (2000:38) explain that language ideologies must ignore or transform elements that do not fit into their interpretive structures. According to them, this “erasure” is one of three semiotic processes that sustain a given language ideology, the others being iconization and fractal recursivity. My discussion builds from this work by suggesting that the “erasure” of spatiotemporal indexes of clients' talk is achieved by an a priori process of iconization (see also Carr n.d.).
Some HFC programs had consumer intern programs in which former clients were hired into the organization, usually in low-skilled, low-wage, high-turnover positions. Lila's case was a bit of an exception, since she was still attending Fresh Beginnings when she was hired, causing much ado among some staff members regarding the propriety of resultant “boundaries.”
Benveniste 1971 distinguishes third person pronouns, which can exist independently of the “I” who utters them, and first and second person pronouns, which depend on and “shift” according to situation in which they are uttered (cf. Silverstein 1976). He writes: “The third person must not [therefore] be imagined as a person suited to depersonalization. There is no apheresis of the person; it is exactly the non-person, which possesses as its sign the absence of that which specifically qualifies the “I” and the “you” (1971:200). Arguably, Lila takes advantage of the absence using they as a “shifter.” Yet to the extent that Laura's analytical labor is successful, Lila's once “shifting” pronoun falls victim to what Silverstein 2004 calls “indexical iconic semiosis,” a process that collapses the spatiotemporal properties of signs so that they appear independent of their context and purely denotational. We might render Laura and Lila's respective labor as follows:
More specifically, while Lila finally suggests that her they is an index of an institution that may not welcome the gender of her partner, Laura fixes Lila's gender-neutral pronoun as an icon of her presumed “gay shame.”25
As clients progressed through treatment, therapists reasoned that it was not just denial but also shame that prevented clients from articulating their histories, especially as those histories related to sexual experiences. Therapists, in line with their colleagues in women's treatment (e.g., Finkelstein 1996, Winick et al. 1992), posited that shame was one of the “three emotions that [are] most likely trigger relapse” in addicted women. (Laura identified the other two emotions as fear and anger.) Arguably, the story of Lila demonstrates how “gay shame” can be semiotically conferred. Along these lines, Tompkins 1995 likens shame to a yawn, passed from one agent to another in mysterious sociality. According to Tompkins, shame becomes an individual attribute only because it is understood as such, just as the yawn is interpreted as a sign that the yawner is tired rather than as a reflexive expression of mutuality.
Lila did transfer to another program, and she continued to express regret, hurt, and surprise at the circumstances of her departure while maintaining friendships with several clients still attending the program. Several years after this incident, while working as a travel agent, Lila died of a heart attack. Fresh Beginnings and HFC staff suspected a drug overdose. Talk of shame quietly persisted.
CONCLUSIONS: HEALING AND SEALING
The talking cure is based on the assumption that words can do much more than refer to sick selves; they can also produce healthier ones. In fact, social workers and social scientists alike have lauded the instrumental potential of referential language, suggesting that talk can help people build and experiment with new and possible selves (e.g., Benveniste 1971, Labov & Fanshel 1977, Bruner 1990, White & Epston 1990, Anderson & Jack 1991, Borden 1992, Nye 1994, Capps & Ochs 1995, Crapanzano 1996, Ochs & Capps 1996, Passerini 1996, Sands 1996). Furthermore, the clinical successes of Alcoholics Anonymous, an approach heavily reliant on personal narrative (e.g., Bateson 1971, Denzin 1987, Wilcox 1998, Brandes 2002) indicate the potential therapeutic benefits of autobiographical talk specifically for those coping with addictions.
With this in mind, I wish neither to indict talk therapies per se, nor even to challenge the idea that one must refer if one hopes to produce. Instead, I am concerned with the political effects of a language ideology that allows people's words only two referential possibilities in relation to a single property: revealing or denying inner truth. By following the fate of Lila's plural pronoun, we can see that such an ideology, when mobilized as a clinical regimen, severely circumscribes the truths that she can felicitously produce. And, although it would be quite easy to focus on Laura as an unusually power-hungry and manipulative therapist, we would be wise to note that her troubling analysis of Lila's they survived long intertextual travels through a large network of people dedicated to helping others.
If the linguistic analyst were to follow in Fresh Beginnings' footsteps, she might take therapists' and clients' metalinguistic reports, gleaned during her research, as transparent and conclude that honest talk will indeed heal the addicted speaker. After all, Louise enthusiastically reports that “talking it out” is healthier than “acting it out,” trading in her resistant “philosophy” for honest, open, and willing talk. If clients feel better after using the language of inner reference, we might well laud it for accomplishing its therapeutic aims. However, as the case of Lila poignantly illustrates, our analysis of clinical language should not stop here, complacent with such seeming psychic triumphs. Indeed, if, our linguistic analyses are to be useful in the clinic, they must draw attention to the situatedness of clients' talk and investigate the linguistic relationship between cure and context.
As both an anthropologist and a social worker, I am dedicated to thinking through the political effects of very common ideas about language. Here, working against the ideology of inner reference, I attempt to do what Lila, as a client at Fresh Beginnings, could not: to connect her words felicitously with her institutional and social surrounds. For if we are to include in our definition of “health” an ability to act and speak as a political agent, we should recognize the ways in which clients' words “refer” to the conventional, spatiotemporal, and interactive contexts of their articulation. We should also recognize the grave danger in leaving such critical indices unheard.
