Psychic retreats into heroin: institutional trauma and loss in the lives of substance using mothers

This ethnographic study considers the accounts of 12 new mothers in recovery for heroin addiction. Using structured interviews, it aims to uncover the historical and ideological contexts of their experiences and seeks to understand how these experiences intersect with axes of power, oppression, and structural inequality. The study draws upon object relations, attachment theory, Lacanian analysis, critical theory, theories of liberation psychology, and a biopsychosocial approach to addiction and harm reduction. It asks: in what ways do interactions with oppressive systems of race, class and gender impinge upon substance using mothers? And how do historical and ideological constructions of motherhood and addiction insidiously insert themselves into the mother-infant dyad? The study identifies three areas of institutional trauma: exclusion from language, loss and bereavement, and sociocultural shame. It argues that these combined institutional harms trigger a psychic retreat into the primordial, preverbal, somatic realm of heroin. Interviews reveal how institutional systems of control constrict voice, language, and symbolization, all of which are central to the phenomenology of addiction. They further r show that many women suffer a profound and enduring loss from child removal, which increases their risk of future substance use. Analysis of the child welfare system points to structural problems of race and class bias that lead to excessive child protection enforcement. Interviews show that substance using mothers experience a unique duality of shame: the pathogenic shame inherited from their early traumas and a sociocultural shame specific to social constructions of motherhood and to the phenomenology of oppression. The study’s findings stress the need to keep mothers and infants together in drug treatment, and provide strong support for a harm reduction approaches to addiction treatment. It concludes that addiction policy should adopt a harm reduction focus, including the decriminalization of heroin and other drugs, improving access to medication assisted therapy (MAT), and increasing social welfare spending. Finally, the study concludes that therapeutic work with substance using mothers calls for a radical psychoanalysis that bears witness to the trauma of oppression, supports the development of imagination and resistance, and advances the goals of psychic and social liberation.Psy.D.Includes bibliographical referencesby Cassia Mosdel