Hispanos in the Valley of Death: Street-level trauma, cultural-PTSD, overdoses, and suicides in North Central New Mexico.

摘要

New Mexico has had the highest per capita drug overdose death rate in the United States, about 18 per 100,000, for more than ten years -- 1995 to 2006. The USA's rates for the same period are about 5 per 100,000. North Central New Mexico (the Valley) has the highest per capita "accidental drug overdose" death rate in all of New Mexico ranging from 42 to 72 per 1000,000 over the course of the eleven years examined, from 1995 to 2006. What are the differences and similarities between victims of "accidental drug overdoses" and suicide victims in the Valley (as subjectively designated by the Office of the Medical Investigator)? How can we understand these high rates of suicide among the Valley residents, most of whom are Hispanic? What are the race, class, and gender structures that set the backdrop for the high rates of overdose and suicide in the Valley? This dissertation examines the social forces that may contribute to the overdose epidemic among the predominantly Hispanic population in Northern Central New Mexico. My analysis of 34 interviews of active illicit drug users and 10 interviews of family members and professionals, is anchored in sociological analysis, concepts, and literature -- Anomic Suicide, post-Marxism, current sociological drug addiction theory, colonialism, historical/cultural trauma, and racial and ethnic inequality. The research design employs both qualitative and quantitative data, including data from the New Mexico Office of the Medical Investigator (1995-2006), historical analysis, participant observation, in-depth interviews, and autoethnography and positionality. This mixed method approach allowed for the triangulation of disparate data. I found that there was an overlap between the demographic profiles of suicide and overdose victims. I argue that the effects of colonization and "street-level trauma" (SLT) (which I define as interlocking traumatic shocks that are puissant and pervasive: chronic and acute emotional, physical, and psychological insults that are pernicious, debilitating, and untreated, and which may lead to mortality inducing behavior) may lead to a condition I call "Cultural-post traumatic stress disorder" (C-PTSD). C-PTSD may result in high incidence of morbidity and mortality amongst Hispanos in the Valley. C-PTSD may be shaped by the loss of arable land (despite high home ownership), loss of traditional and cultural norms, the whole-cloth invention of a mythological and superficial ethnic consciousness (categorical awareness), and loss of meaningful social bonds to community. When C-PTSD and SLT are coupled with a substance abuse career, the combination of all three may prove lethal; may result in suicides that are labeled "accidental drug overdoses. The implications for medical sociology are important. Treating drug overdose and suicide as a "personal trouble," an individual-level problem in the Valley, is a major limitation of current health policy. Public health programs must be implemented that do more than attempt to treat substance abuse and fail to go beyond that. My findings suggest that a community-level approach that includes an analysis of the matrix of domination (e.g., intersecting structural, disciplinary, hegemonic and interpersonal oppressions and resistance) would shed light on the social forces that shape community health and viability. Future research should also examine the intersection of race and gender vis-a-vis hegemonic and subordinated masculinities and health policy.