The chronotope of the queue: Methadone maintenance treatment and the production of time, space and subjects

Abstract

This paper considers methadone maintenance treatment as a temporal and spatial phenomenon, a set of practices and arrangements that operate ‘intra-actively’ in response to, and in provocation of, certain kinds of subjects understood as ‘methadone clients’. In doing so, the paper uses Australian interview data on everyday experiences of methadone dosing to look at methadone maintenance treatment in terms of two sets of theoretical concepts: Mikhail Bakhtin's chronotope; and Karen Barad's formulations of the space–time manifold and of what she calls iterative intra-activity. The paper argues that in the context of the methadone dosing point, time and space co-produce each other as a chronotope of the queue, and that this chronotope helps materialise particular methadone subjects. Often, these are the very kinds of subjects considered undesirable; that is, the ‘unproductive’, the ‘disorderly’, the ‘illicit’. In light of this, the paper asks whether the demands of the clinic and its convention of queuing reproduce rather than depart from the model of waiting and dependence widely seen as characteristic of lifestyles associated with regular heroin use. In conclusion, the paper considers the policy and practice implications of the chronotope and of its role in methadone maintenance treatment.

Introduction

In Australia, methadone maintenance treatment commits clients to regular contact with prescribing doctors and, in particular, with the agencies through which methadone doses are dispensed. In New South Wales, this means that clients can expect to visit their dosing point between three and seven days per week (NSW Health, 1999, p. 27). This paper explores the ways in which methadone maintenance treatment clients describe their experience of dosing, focusing on the issue of waiting, as this constitutes a central and abiding theme in client accounts of treatment. In doing so, the paper considers methadone maintenance treatment as a temporal and spatial phenomenon, a set of practices and arrangements that operate ‘intra-actively’ in response to, and in provocation of, certain kinds of subjects understood as ‘methadone clients’. It uses interview data on everyday experiences of methadone dosing to consider methadone maintenance treatment in terms of two sets of theoretical concepts: Mikhail Bakhtin's chronotope; and Karen Barad's formulations of the space–time manifold and of what she calls iterative intra-activity. The paper explores the ways in which, in the context of the methadone dosing point, the specific actions of time and space co-produce each other as a chronotope of the queue, and how this chronotope helps materialise particular methadone subjects—often the very kinds considered undesirable; that is, the ‘unproductive’ the ‘disorderly’, the ‘illicit’. It also takes into account the ways in which that the actions of clients fold back into the chronotope, sometimes creating change, sometimes reinforcing elements of the organisation and process of the dosing point. In producing this sometimes critical account of the processes by which methadone maintenance treatment is delivered in New South Wales, my intention is not to deny the value of the programme. Rather it is to illuminate ways in which the programme operates, and the implications of these operations for the subjects of methadone treatment.

In pursuing the issue of waiting and queuing that arises so powerfully in the interview material, it is useful to turn to the literature dealing with addiction and time. Several authors have considered drug use and the experience of addiction in terms of temporality (Keane, 2002, Klingemann, 2000, Lenson, 1995, Reith, 1999). In his book entitled On Drugs (1995), David Lenson argues that becoming and being addicted to drugs involves a shift in consciousness in which time becomes ‘atomised’ (p. 33), that is, broken up into separate moments given meaning by the search for and administration of drugs. Drug addicts, he asserts, find it difficult to escape addiction precisely because they are faced with making the return to the monotony of ‘horizontal’ or ‘pre-drug’ (p. 34) time, an unappealing prospect impossible to contemplate while the enticing memory of drug time lingers.

Lenson's account of addiction temporality is both thought provoking and troubling, not least because, although he makes clear his view that drug use is a matter of degree not kind (p. 31), his analysis implies a rather rigid distinction between addicts and others in its construction of addiction as temporal atomisation in contrast to the smooth waves of non-addicted temporality. Addicts, he suggests, remove themselves from ‘conventionally measured time’. Thus, he states:

What characterizes the condition of addiction is above all else … the replacement of conventionally measured seconds, minutes, hours and days with a different chronometry based on the tempo of administration. (p. 35)

It is not clear here what is meant by ‘conventionally measured’. The term suggests something like Bergson's clock time, yet Bergson (1955) explicitly distinguishes clock time from lived time. Who might it be that possesses a sufficiently generic relationship to time as to experience it as ‘conventionally measured’?

Like Lenson, Gerda Reith (1999) also describes addiction as a kind of re-ordering of temporality, noting that in interviews conducted with ‘ex-opiate addicts’ the state of addiction was described as a period of ‘lost time’ characterised by an inability to envisage the future. The recovery from addiction was expressed as a re-animation of the future and an ‘awakening’ from the previous state of present-oriented temporality into a state in which temporality is experienced conventionally. This issue—the possibility of making a meaningful distinction between conventional (‘normal’, ‘non-’ or ‘ex-addict’) time and drug time—is canvassed briefly by Helen Keane (2002) in her book What's wrong with addiction? She analyses the temporality of smoking, and the tendency to view smoking as a form of disordered temporality in which insufficient attention is paid to present activities and their likely impact on future health. In contrast to Lenson and Reith, she argues that:

The distinction between the disordered temporality of addiction and the natural, unthreatening passage of normal time is hard to maintain. It is not only the addicted who are unable to live in the present. (p. 105)

In that temporality and subjectivity are closely aligned, it is perhaps understandable that Lenson's argument is not confined to questions of temporality. Like the pre-drug and post-drug time described in his book and echoed slightly differently by Reith (as addiction and non- or ex-addiction time) Lenson also writes of pre-drug and post-drug thought:

Once time has been atomized according to a pattern of drug administration, the very existence of memory prevents an easy reversion to ‘natural thinking’. (p. 33)

Presumably in deference to critiques of the self-evidence of the natural (see Grosz, 1994, Haraway, 1991, Haraway, 1992), Lenson quarantines the last two words of this sentence in quote marks, yet his investments are clear. He argues that once a drug has been consumed (or at least, consumed ‘regularly’), consciousness is in some way permanently recalibrated. Implied in this assertion is the idea that there is indeed a distinct ‘natural’ (‘pre-drug’) consciousness in the first place. Both time and thought, in this account, are radically divided along before and after lines, constituting ‘before’ in naturalised terms.

In that Lenson tends to rely on commonplace divisions such as those operating in relation to notions of a priori naturalness or absence and post hoc alteredness or presence, it is perhaps unsurprising that conceptual categories such as time and space also remain divided in his analysis. In thinking about the issues of waiting and queuing in relation to the material collected for this paper, however, it is clear that the queue cannot be seen purely as a temporal phenomenon. Consider the following extract from an interviewer's fieldnotes on her meeting with client ‘Mary’ (aged 24 years):

As Mary left the clinic, she passed the queue of clients waiting to be dosed, and was suddenly punched in the eye by a waiting woman. […] The sole entrance/exit to the public clinic is accessed via a ramp with a railing. The railing restricts movement along the ramp, that is, there is no way out except via the ramp and the queue running alongside it.

Despite the confusion that followed the attack on Mary, it was obvious to the interviewer that the assault was the product of more than individual agency—that it would not have occurred (at least in the way it did) in the absence of a queue. Certainly, the role of temporality is obvious here. Yet while the clinic's temporal mode (waiting) was clearly instrumental in the incident, the spatial arrangements in place also contributed to orchestrating it. Without the peculiar set-up obliging clients to leave via a ramped exit directly in front of the waiting line (with the ramp and its containing rail actively funnelling exiting clients past those still waiting) the assault might not have been possible. In other words, both temporality and spatiality combined with individual agency to produce the event, indeed, they were always already inseparable in it. As will be argued below, time and space are indivisible: they produce each other in specific forms. It is true that Lenson grants a role for space in the texture and character of addictions. Along with time, and in keeping with his tendency towards the possibility of neutral forms evident in his reliance on notions of the natural, Lenson terms space a ‘medium’ for consciousness (p. 37). However, his focus rests almost exclusively on temporality.

The approach taken in this paper possesses some similarities to those approaches taken by both Lenson and Reith in that, prompted by the concerns expressed in the interview material, I too have turned to temporality in understanding drug use, and specifically, life on methadone maintenance treatment. Shot though with intensely expressed concerns around time, most explicitly, waiting, many of the interviews place temporality at the very centre of experiences of treatment. Unlike Lenson and Reith, however, my analysis operates directly from an insistence on the inseparability of temporality and spatiality, and specifically, on the temporality of waiting that is found in the interviews as also the product of spatial arrangements. In this respect, this paper proceeds from three main insights.

The first insight is that the workings of time and space in methadone maintenance treatment cannot be examined separately if an adequately complex picture is to be produced, and that quarantining the two from each other would likely provide cover for other questionable divisions. Secondly, temporality and spatiality should not be treated as ‘media’ for consciousness and experience. Rather, all manifestations of time and space must be treated as specific; as active, in their specificity, in the production of consciousness, and, in turn, as themselves the product of consciousness. Thirdly, the temporality of methadone maintenance treatment is not strictly distinguishable from the temporality of other parts or forms of life. That is, a ‘normal’ temporality against which ‘methadone temporality’ can be compared and identified as abnormal should not be assumed. Instead, the temporality of methadone should be understood as possessing characteristics found elsewhere in life. These characteristics, however, are also invested with a specific intensity and significance in this context. With these insights in mind, I turn to the work of Mikhail Bakhtin and Karen Barad to elucidate elements of the relationship between time and space, and to begin to consider in more detail the ways in which this relationship might shape life on methadone maintenance treatment.

Russian theorist Mikhail Bakhtin (1981) developed his theory of the chronotope (or ‘time–space’) as a means of analysing the historical development of the novel. Based on an analysis of literary works, Bakhtin proposed several chronotopes including the chronotope of the road and the chronotope of the castle. Inspired by Einstein's theory of relativity, he argued for the ‘intrinsic connectedness’ of space and time, and for the specificity of chronotopes in different genres and historical periods. According to Bakhtin, chronotopes are the:

organising centers for the fundamental narrative events of the novel. The chronotope is the place where the knots of narrative are tied and untied. It can be said without qualification that to them belongs the meaning that shapes narrative. (p. 250)

This notion of the inseparability of space and time, and the constitutive role the chronotope plays in relation to narrative, can be adapted from literary criticism to social and cultural analyses (Vice, 1997, p. 209; see for example, Harden, 2000, Jones, 2003). Drawing on Bakhtin's theory, then, I argue that time and space always shape each other (that is, each is a necessary constituent of the other), and, in relation to the subject of this paper, that it is the mutual shaping of time and space under specific circumstances that produces the particular chronotope of the methadone dosing point, simultaneously producing particular methadone subjects. Likewise, the dosing point and its clients also produce the forms of time and space at work. In order to explain and draw out some of the implications of this notion of time and space as always already co-constitutive, I now turn to the work of Karen Barad, who, like Bakhtin (and Lenson), takes inspiration from physics.

In her paper, ‘Posthumanist Performativity’, Barad (2003) uses the work of physicist Niels Bohr to generate new perspectives on the agency of objects, the nature of matter, and causality itself. Her central question focuses on the tendency in recent thinking to understand reality as shaped by discourse (the ‘linguistic turn’), and to ignore the role of materiality in this process of production. She asks: how can we acknowledge the role of materiality in the production of realities without characterising that role as determining, and reality as therefore ‘natural’ or unchangeable? She begins with a discussion of the western view of representation that highlights the tendency in western thought to assume a split between the observer (or her/his expression: discourse or words) and the object observed (‘reality’, or things) arguing that representation should not be seen as separate and distinguishable from that which is represented. Her intention is to blur the boundary between observer and object (language and referent, representation and entity). Following Joseph Rouse, she identifies this boundary as the product of Cartesian thinking which entails a commitment to an inside/outside binary. It is this Cartesian binary that is echoed in the before/after, original/altered analysis of drugs and time offered by Lenson.

Barad (1998) goes on to elaborate her concept of ‘agential realism’ (first introduced in 1998) in opposition to this split, arguing that contrary to conventional wisdom:

‘Subjects’ and ‘objects’ do not preexist as such, but are constituted through and within particular practices. (p. 106)

In making this case, she rejects the widespread idea that subjects and objects (such as the observer and the object of observation) have independent existences, and that they possess pre-existing attributes (that is, what she calls, following Bohr, ‘relata’) which ‘interact’ when they encounter or form relations with each other. Drawing on Bohr, she counters the notion of independent entities and their relata with the ‘phenomenon’. Phenomena possess attributes only insofar as these are constituted in their inevitable encounters with other phenomena. All subjects and objects are to be understood as ‘phenomena’, that is, as always produced through the inseparability of object and observer, and the relations between them are to be understood as occurring ‘without pre-existing relata’. By displacing the notion of the independent object which possesses inherent boundaries and properties (p. 815), the phenomenon destabilises conventional formulations of causality. It questions the assumed causal chain from pre-formed objects (with inherent attributes—relata) to their subsequent relations, then to meaning, and replaces it with what Barad calls the ‘intra-action’ of phenomena. Intra-action is distinct from ‘interaction’ in that the latter ‘presumes the prior existence of independent entities/relata’ (p. 815). In short, Barad argues that all subjects and objects are always already the product of other subjects and objects; in this respect they do not exist independently of, or outside, each other. The relations between them should be understood as ‘intra-active’ in that this term refers to action within, rather than action between. In that subjects and objects produce each other in fundamental ways, and are not independent of each other, there are no stable ontological boundaries (that is, boundaries at the level of essence or being) between them. This absence of boundaries between objects entails the absence of independent, isolatable effects on other objects, on the observer, or on ‘reality’. In other words, if objects do not have inherent attributes separate from the contingent processes of observation or of intra-action with other objects, they cannot be seen in conventional terms to be impacting independently or consistently on other objects, or as ‘determining’ reality in predictable ways.

Pursuing her interest in the practices of science, Barad (2003, p. 816) mobilises this theory to discuss the status of scientific apparatuses, which she argues are all too often seen as stable, pre-formed objects that ‘sit atop a shelf’, employed to produce stable, objective measurements of a pre-existing reality. On the contrary, they are ‘neither neutral probes of the natural world nor structures that deterministically impose some particular outcome’ (p. 816). Rather, apparatuses and the entities they seek to measure always already constitute each other (they are all phenomena). Barad uses the example of the apparatus here quite specifically in relation to scientific practices, but it is possible to consider the implications of framing methadone maintenance treatment and apparently pre-formed ‘phenomena’ such as the dosing point, in light of her arguments. What emerges when we do not assume the programme to be either neutral or determining? What are the effects of treating methadone maintenance treatment as phenomenon, that is, as an entity made in its intra-actions with other entities and bereft of relata? These questions will be considered later in the paper.

Barad's summary of her agential-realist model is a particularly productive starting point for thinking about the interview material collected for this paper. She poses the ‘human’ as phenomenon, thus reconstituting the boundary between human and nonhuman (including inanimate matter) as itself indeterminate and unstable. This move also refigures agency as produced not by humans in the traditional sense, but by humans and objects, discourse and materiality in their intra-action. In this respect, Barad's theory challenges conventional assumptions about the autonomy of three elements: the knowing subject, discourse and matter. In doing so, it opens up ways of understanding the co-construction—the intermingling and fluid intra-action—of all kinds of phenomena, such as methadone itself, the programme's clients, and the chronotope of the dosing point.

Indeed, Barad (2001, p. 93) has much to say of relevance to the chronotope, focusing in one paper on the intra-activity of what she calls, after post-Newtonian physics, the ‘space–time manifold’. In keeping with her formulations of intra-action and the phenomenon, Barad conceptualises space and time as mutually constitutive, and as productive of material realities:

Intra-actions are causally constrained but nondeterministic irreversible enactments through which matter-in-the-process-of-becoming is sedimented out and becomes an enfolded ingredient in the further materialisation of human, nonhuman and cyborgian bodies; such a dynamics is not marked by an exterior parameter called time, nor does it take place in a container called space, but rather iterative intra-actions are the dynamics through which temporality and spatiality are produced and reconfigured in the (re)making of material-discursive boundaries and their constitutive exclusions. (p. 90)

Here, Barad recognises that time and space are more than pre-existing agents that act on pre-existing subjects and objects to produce stable outcomes. Rather, they are always already the product of each other and of specific intra-actions with other always already intra-actively produced phenomena. This insight can be applied to the chronotope, providing a productive starting point from which to consider the action of space and time in the case of the methadone dosing point.

Having questioned Lenson's tendency to reify and compartmentalise drug time and thought, this paper's intention is to consider the action of space-time in the materialisation of the methadone dosing point in a manner that eschews assumptions about points of origin and about causality, and which asks the following questions: what emerges when Bakhtin's chronotope is overtly formulated as a product of the iterative intra-action of space and time, and of discourse and material objects? How does space–time help produce the character of the methadone dosing point, and how does the dosing point (its location, layout, staff and clients) produce particular forms of space–time (particular chronotopes)? Similarly, how is the client (assumed to be merely observed and ‘treated’ by the programme) intra-actively constituted by the dosing point and its chronotope? Most importantly, what implications do these multiple iterative intra-actions have for methadone clients and their relationships to the programme, and for drug treatment policy and practice?