Recovery | “The Opioid Crisis” with Brett McCarty

Show Notes:

Dr. Brett McCarty joins Chris (no Eddie this week)  in a conversation about the intersection of faith and healthcare, specifically as it relates to the opioid crisis in the US. Dr. McCarty is a theological ethicist from Duke University, where he is the associate director of the Theology, Medicine, and Culture Initiative at Duke Divinity School. He has written essays in  The Journal of Medicine and Philosophy, the Journal of the Society of Christian Ethics, and the compilation Spirituality and Religion within the Practice of Medicine. Dr. McCarty’s research has centered greatly on the recovery communities of Appalachia and how these communities create space for truth telling, healing, and the transformative power of walking with someone through a journey of recovery.

Transcript:

Chris McAlilly 00:00

Hi, I'm Chris McAlilly. Welcome to The Weight. I'm here today by myself. Eddie got pulled away into some pastoral ministry work. And I'm talking today with a researcher and professor of theological ethics, Brett McCarty. He's working at the intersection of biomedical ethics, public health and theology at Duke Divinity School and the School of Medicine at Duke University. And he's really interested in questions that are surrounding the opioid crisis. This is the beginning of a new series for us on addiction and substance abuse, where we're looking at some of the large problems in America related to overdose and substance abuse. It turns out, you hear in the conversation that just in the year 2020, the numbers recently came out that 90,000 plus people died of substance abuse during 2020.

Chris McAlilly 01:06

[INTRO] Life can be heavy. We carry around with us the weight of our doubt, our pain, our suffering, our mental health, our family system, our politics. This is a podcast to create space for all of that.

Chris McAlilly 01:06

We knew that the impact of social isolation was going to have an effec-- that's a 30% increase over the previous year, so the issue is real. It's deep, and it's complex. And we talked about some of the dimensions here. One of the things that is at the center of Brett's research is the concept of agency, the idea that we can act freely towards the good. And he also talks a lot about conversion, what it looks like to be able to tell a story of a journey of transformation out of addiction and into a flourishing individual life and a social community. We talk about AA and NA, the recovery community, of course. We talk about some of the really complex powers and principalities and challenges that affect us on a large scale and systemic scale. And we also talk about the power of testimony, and the witness of particular churches in the region of southern Appalachia, that I think are a way that we can come away from the conversation with some things to maybe think about or do or to have a kind of moral imagination for what it might look like in a local community, to be engaged in important conversations and work around these matters. Thank you for being with us as always on The Weight. Like, share, and tell your friends about the episode. Thanks so much for being with us.

Chris McAlilly 01:27

We want to talk about these things with humility, charity, and intellectual honesty. But more than that, we want to listen. It's time to open up our echo chamber. Welcome to The Weight. [END INTRO]

Chris McAlilly 03:08
We're here today with Brett McCarty. Brett, thanks so much for taking the time to be with us today.

Brett McCarty 03:14
Yeah, thanks so much for having me, Chris. I appreciate it.

Chris McAlilly 03:17

You are doing a lot of really interesting research and work. And you work as a theological ethicist. For folks who don't know what that is maybe, could you give just a bit of your background and how you ended up in this vocation?

Brett McCarty 03:34

Yeah, no. No, thanks. So yeah, I'm a Christian ethicist, a theological ethicist, who works particularly with attention to questions of health and healthcare. And honestly, my interest in it comes from early dinner table conversations with my wife, who's a pediatric physical therapist. When we first got married, I was an MDiv student at Duke Divinity School and she was working in the NICU at Duke's hospital caring for the neonates, the small, premature babies. And I would come home with questions about, you know, Augustine, Calvin, Kierkegaard, womanist theology, and she would come home with questions about why did this baby die today? And why did this family that loved this child so much, care so much for this child.

Brett McCarty 04:26

So those conversations were a lot more gripping and really important than the ones I was coming home with. And in conversation with her and some faculty mentors, I really pursued this work because I believe that Christians working in health care, have a deep, rich resource and trove of resources to draw on within the church and our history. But oftentimes in their practice, they feel pretty alone and struggling with the suffering that they face and the frustrations that they feel. So how can we help equip Christians to be more faithful agents within the healthcare world? That question has drawn me in my work.

Chris McAlilly 05:04

I know that some of the writing that you've done and some of some of the work that you sent for us to take a look at in preparation for the conversation is really centered around the opioid crisis in the American context. I know that you've written about that. And I wonder, the paper that I read is called "They're in the Grips of Hell." And you talked about a woman named Allie, I know that's not her real name, but I wonder if you could maybe just tell a bit of her story.

Brett McCarty 05:37

Yeah, no. Thanks. So, Allie is in her mid 50s. But earlier, she was really struggling with cycles of substance use issues and addiction. And for a while had her kids taken away by the state because of her time in jail. And she was telling me the story of this in a conference room, in southern Appalachia, this Community Resource Center. And I was completely transfixed. I'd heard her speak recently, because she experienced a deep conversion when she found herself at a small Methodist Church in the area, and a pastor who wouldn't give up on her and who showed her the love of Christ. And that church, she said, loved her into a better person.

Brett McCarty 06:37

But as she was described--so she now does peer recovery counseling for women who face similar situations to her own, who were either pregnant or with young children and struggling with substance use issues. And as she's describing the just intense difficulties that she faced and the women that she worked with faced, I mean, she just, it was just seared. She said, you know, "They're in the grips of hell. I mean, that's what it is. It's actual hell, and nobody wants to do it. You think these moms want their babies took? Do you think that we want to go sit in jail. It's not like this is fun, I want to do it. It's just not."

Brett McCarty 07:18

And I just, to sit before her witness of the intense difficulties of her life and her story and the women's that she worked with, and what it might mean for her and those women to find agency and flourishing is just such a huge question. What does it mean to be released from the grips of hell? That question has propelled me and my work.

Chris McAlilly 07:45

I know people in the recovery community, people who've struggled with addiction, people who have lost children to substance abuse to the opioid crisis. And I would imagine that there are a lot of people that are across the country that have been personally impacted. But I wonder if you could just kind of give folks a scope, a sense of the scope of the problem in America, for folks who maybe have been swept up in, you know, I feel for real reasons around COVID. I think, coming back to the opioid crisis, because there's an intersection and relation. I wonder if you could just kind of help people understand how big this problem really is, right now.

Brett McCarty 08:33

You know, it's huge. And it's all bound up with all sorts of other problems. It's a wicked problem, you know, one that if you just try a simple solution to it, you're probably going to make it worse. And, you know, and it's been going on for decades from over prescribing practices by some greedy physicians, but also some who are just overworked, seeing a rising caseload of patients in pain. Definitely greedy pharmaceutical companies, doing incredibly aggressive marketing practices. And some of the folks listening may have seen news this past year about big settlements with Purdue pharma and others, about their immoral activities that really catalyzed a crisis that goes far beyond the question of illicit prescription drugs now.

Brett McCarty 09:32

Because with fentanyl, a kind of synthetic heroin, you have a potency far beyond what's even in the most potent oxys--oxycontin pill--and oftentimes delivered in ways that folks on the street don't really have any clue what the power of the dosage is and all that leads to just a situation ripe for death from overdose. And so last year, overdose deaths in the US increased by 30%, the largest jump on record. And over 90,000 folks died from overdoses in the US last year. And well over half of those are in some way connected with the opioid crisis and its current iterations.

Chris McAlilly 10:19 That's insane.

Brett McCarty 10:21

It's a huge number. I mean, it's more than accidental gun deaths or car accidents. I mean, it's huge. And beyond that, the amount of families and friendships and communities that are torn asunder through the struggles with substance use issues and the cycles of difficulty that come with that--it's huge.

Chris McAlilly 10:47

Yeah, I mean, I just think, you know... I'm just struck by just the gravity of that, of those numbers and the complexity of the problem. And it's debilitating. I think one of the things I note that about your research, that you're really interested in questions of agency, and I wonder if you could just, perhaps, kind of define what you mean by agency?

Brett McCarty 11:17

Yeah, um, the power to pursue the good. What is it? Are you able to pursue good things? And oftentimes, for variety reasons, we're not able to, whether because of the systems we find ourselves in, or the distortions of our will, anything from substance use issues to toxic relationships to childhood trauma, to just what you would say, in an old school way, just kind of festering patterns of sin, like, for all sorts of reasons, it can be really hard to do good. And so agency, I try to really understand conditions of possibility for folks to better be able to do good. And that's what I mean, by agency.

Chris McAlilly 12:16

Yeah, I think the way I've been thinking a lot about this lately, just because of decisions that I've just been thinking about the way--and this is not you know, a person who just kind of in the grips of addiction, but just we know what this feels like. We know what it feels like for our choices and our decisions to be constrained by the stories that we're living in, by the stories that other people are, or the roles that we're in, the situations that we're in. It's a very real factor. But there's usually not the complete decimation of agency in a regular, normal life. And it seems like that's one of the things that for folks who haven't been in the grips of addiction that you draw attention to in the stories and the accounts that you've you've listened to.

Brett McCarty 13:05

Yeah, no, that's right. And I think there's a lot of thoughts swirling with the way that the opioid crisis in Appalachia is, as one physician said, it's not some kind of other problem. It's a mirror to America of our own social issues. From you know, extractive, exploitative economic practices that have crushed folks' bodies--the coal miners, like what they went through to bring out coal so that we could do what we like to do. And our economy has decimated their bodies, which made them ripe for these cycles of addiction. And that's just one case of many of the ways that Appalachia has been exploited.

Brett McCarty 13:53

And I think there's... So what does it mean for poor folks in Appalachia to both experience the decimation of agency and also show us, show those of us not specifically in that region, what it means to pursue flourishing in the midst of really difficult situations? I'd love to turn to that in a minute, some of the witnesses of churches there, but, but also, I think, so that gets a lot of questions of class and economic agency. And then there's also, this connects up with big racialized questions, too, about, you know, why was crack cocaine criminalized in the 80s and, you know, the prescription pill epidemic has been medicalized so that, you know, it's a public health concern, not a criminal justice concern and the ways that's affected Black and white folks differently. That that intersects with this question also, but it also points to how the Black church and ways that its members have experienced the decimation of agency is also a site that that can witnesses to what it means to pursue agency and flourishing, when the world might be bent against you, for different, but sometimes intersecting, reasons. So, yeah, those spaces that show us what it means to come out of that decimation are sites that I'm really interested in listening to and learning from.

Chris McAlilly 15:22

I mean, this is... I mean, there's just a major question in American culture right now. And I know that people look at it, the opioid crisis from a number of different perspectives and lenses. I mean, there's a public policy dimension, and there's kind of a biomedical dimension and, you know, ways in which we might engineer a set of drugs or a set of solutions technologically that could be helpful. I wonder for folks who are maybe not inclined to think of this theologically, or from the perspective of the resources from the church, what is it that the church offers? Or what is it that the language of theological ethics can offer to the conversation that's not there otherwise?

Brett McCarty 16:09

Yeah, that's a great question. Some of my research has been on what prevents organizations and institutions from collaborating in response to the opioid crisis, in the substance use issues. And oftentimes, it's because different sectors are talking about and approaching these issues in very different ways. So the criminal justice system sees crime and responds with punishment and maybe some rehabilitation. But there's, you know, you have a whole way of responding to issues that are through the lens of criminal justice. Public health approaches are going to be different. Local healthcare systems see disease and want to treat. You have economic ways of looking at the need for jobs and workers. But all these different approaches see problems differently. And oftentimes, that means that they don't work well together, because they're talking about the stuff and acting in very distinct ways.

Brett McCarty 17:19

What I think that Christians, along with other robust religious communities, can offer is a kind of overarching framework of describing what is a thriving community. What does it look like?
What does it mean to pursue the flourishing of a people in a place? And how can we narrate that in overarching terms that folks can buy into with they're different approaches so that we can see what roles the local healthcare system and the job sector and criminal justice responses might play, if ordered towards local flourishing. We can give a lot of theological account of what that flourishing looks like. But there might be a way for different groups to buy into it without always having to buy into our confession of Jesus as Lord, as Christians. There's a lot of common ground to discover, but the contribution of an overarching framework to bring together folks that might otherwise be butting heads, I think, is a real hope of what Christians can offer to the space.

Chris McAlilly 18:23

Right, right. Yeah, I feel like one of the things that I find really interesting as well, just this intersection between kind of the way the recovery community talks about addiction and transformation, and the way in which Christians talk about sin and conversion, or whatever, and I feel like, you know, coming back to your story of Allie, there's this thick description of what it means to lose your ability to act towards the good, you know, the sense that you're in a circumstance where you're in the grips of hell on earth. And that kind of gets you moving towards the Bible, you know, towards Romans and Paul and all the rest.

Chris McAlilly 19:08

I wonder, you know, I mean, one of the things you note is that you can hear echoes of Paul's letter to the Romans "For I do not know, I don't do the good I want but what I do is the evil that I, you know, the evil that I don't want to do is what I do now, if I do what I don't want, it's not I that do it, but sin dwells within me." And that account of sin and kind of the powers and principalities that act on our will from beyond us. I think it's, you know, there is a thick description there that theological or biblical language can offer to account for what's going on. Could you maybe just flesh that out a little bit more?

Brett McCarty 19:51

No, that's great. I mean, Paul there, my colleague, Susan Eastman, has done a good bit of work on the kind of personal and social nature of sin and Paul and she points out that in Romans, you know, sometimes sin is a kind of first-person thing that you're doing. But at times also sin is this outside force. It's like occupying you, which is the language that you just drew from in that passage. And what does it mean that there might be social bodies and forces and principalities and powers that mediate sin and death and their grip upon us. But at the same time, those forces become internalized so that we are participating in our own destruction. So you have both the personal and the social dimensions of sin and death that are at work in the world.

Brett McCarty 20:44

And so what that means is that conversion, to be turned toward the good to life, is inextricably intertwined in this personal and social dimensions. It's not simply good enough to say, "Well, I'm fine. And I'm going to be set on the straight and narrow, and it doesn't matter if anything else has changed around me. I'm good." Because as folks struggling with substance use issues will say, you know, the communities and friendships that you're a part of have a hold on you. And you might think that you're okay, but when you get back in those patterns of relationship and those situations, you're going to slip, as they say. And so it requires this social transformation that accompanies the personal and they're kind of mutually constituting.

Brett McCarty 21:39

And so Allie's story is really powerful, because this church that she was a part of was a huge advocate for her when some of her charges related to her substance use issues and her losing her kids came to court. The folks in church who had seen the power of the Lord's work in her life actually went to court to testify on her behalf, which was just this amazing story of how these local elites had been claimed by her in a way that they offered advocacy for her in the courts. And the judge even referred back to them as her cheer squad. And when you start thinking about the time that it would take to show up in a courtroom and actually walk with somebody and advocate for them and help them seek flourishing that way, that's a big claim. And I want to turn to another story in a second, but I'll just stop there and say that, for her, her own personal transformation and the new social body, this church that mediated life to her, not death, and displayed that life and enabled it through walking through these public spheres and public action was really key for her own transformation.

Chris McAlilly 23:06

I think that that's powerful. And I think that, you know, both kind of Paul's account of sin in Romans, and then this kind of ethnographic description of what it looks like to move out of addiction through conversion, both of them have these personal and social dimensions, that there's a sense in which the there is, you know, you've become a prisoner to things that you have done, but there are also these factors beyond you. And then if you're going to make your way out of that there's a sense in which you have to be drawn... It's not just a set of choices. It's not just a set of decisions, but you have to be kind of drawn into and transformed by and converted into, turn towards the good in community with other people. I mean, clearly, like AA is just, you know, just a ready example of a community that has done this well through time. And it's not a perfect model, but the idea that the church could learn how to love people into the good or towards the towards the good, or into better people is just... It's a powerful idea.

Brett McCarty 24:22

Yeah, and I think there's a huge flip side to it that I want to turn to, which is that the the invitation to conversion extends to the church as well. Because there are... So agency as the power to do good is not just simply the power to make things happen in the world. If that was the case, then, you know, the richer you are, the more prominent you are, questions of race and gender would. be determinative for your ability to do the good. And that, that ain't right, as they say. So instead, when these local elites showed up in court, they might have been able to do less at their job because they were giving up time. But as their life was transformed in walking with Allie, their agency increased, because their lives became ordered more fundamentally to what's good in walking with her. And I think about that often.

Brett McCarty 25:34

So a lot of these recovery communities will meet for the, you know, 12 steps, small groups in a church basement. But sometimes these recovery ministries might have a meal and worship before they split into their small groups. And those church basements, man, they're amazing. They are places to meet Jesus, for sure. Because you go down there, and folks who have no pretension about their ability to make it on their own in life are just singing their hearts out about how the Lord saved them. And they don't mean in some kind of, you know, idealized spiritual sense. They mean that spiritual salvation meant they were facing death and they were brought out into life, like, last week. That's what they are testifying to.

Brett McCarty 26:23

And so I was talking to one of the pastors that helped work with the head of recovery ministry. And he said, I was asked about the relationship between the church basement on Tuesday night, and the sanctuary on Sunday morning. The sanctuary had recently been remodeled for a couple of million dollars, to make it more accessible, which is a great thing, but also to face what it meant for this to be a kind of shrinking, you know, prominent mainline church. And what was the relationship between the Tuesday evening crowd and the Sunday morning crowd? And he said, "Well, it's funny you asked, because recently, some of the folks on Sunday morning, were like, 'Yeah, we should connect with these Tuesday night recovery ministry folks. We should invite them to worship sometime.'" And, you know, of course, assuming that their Sunday mornings is the center of worship. And the folks on Tuesday evening were like, "We would love to worship together. Y'all can come any Tuesday night. You won't."

Brett McCarty 27:27

And it's that flip of center and margin that I think is an invitation to the church to listen, to learn from, and follow Jesus--to realize that our own working out our salvation with fear and trembling might mean showing up on Tuesday night in a church basement and letting the folks there tell me what to do with my life. That is an invitation to personal social transformation and conversion, that us Christians--and by us, I mean I'll speak for myself, white, well-educated, making pretty good money Christians--would do well to listen to that call, coming from the Tuesday evening church basement.

Chris McAlilly 28:09

I mean, I think that's a good word. And, I mean, there's a lot to be said, but I think one of the things that I hear is the invitation to conversion is not just for individuals, it's for communities, and I think it's an invitation into a kind of rigorous honesty about how hard it is to get through the world, and how many factors there are, and then how important it is to be connected to a power beyond yourself, to be ordered towards something good, or to become a better person.

Chris McAlilly 28:43

It makes me think of a friend of mine who used to be a pastor who's now a counselor in a clinical counseling setting. And he talks about how, you know, the place where he had the most energy and the most passion in ministry was always in one-on-one conversations with a couple or with an individual who was struggling. And he realized that, at a certain point, what he got really fired up about was when he saw people who were experiencing nothing but darkness, and they, in those one-on-one conversations or in a group setting, they would sometimes see the first light of day. And he said the place where he saw that the most is in open recovery meetings when he started training to become a counselor. And that was something that he didn't see as much in the church as he wished.

Chris McAlilly 29:34

And I think that, I'm sure there are pastors across the country that can echo that. I wonder why that is, but I think I have a sense of how just how hard it is to live into a certain set of stories about who you are or who we are or who we're supposed to be, and then living into a story that's honest and real about how difficult life is, and the powers and principalities that grip us, that push in on our ability to act well and faithfully.

Brett McCarty 30:12

Yeah, that's right. And the work of testimony is so crucial and powerful for Christians at large, but especially in the recovery community. Folks sharing their testimony of the Lord's work in their life is a regular practice. And as I was talking with my research partners, this first kept bubbling up that folks would refer to that I've never really given much thought to before, and it's in Revelation 12, you have this, you know, epic apocalyptic scene with Michael and his angels fighting against the dragon and his angels, and the fall of Satan, the deceiver of the whole world, and there's this loud voice in heaven that proclaims following Satan's defeat in Revelation 12:11 it says that "they have conquered him by the blood of the Lamb and by the word of their testimony." And folks would keep referring to this, "we conquer by the blood of the lamb the word of their testimony." And I think, you know, you might hear that and be like, well, I guess, mountain folk have a certain take on Christianity, and we can, you know, respect that in a kind of like, distanced...

Chris McAlilly 31:34
In a distanced, NPR kind of way.

Brett McCarty 31:36 Yeah, yeah.

Chris McAlilly 31:37
"Oh, that's very interesting..."

Brett McCarty 31:39
Yeah. "Ohhh, interesting." And making them into the cultural other, which, gosh, has huge roots

with Appalachia and the work of exploitation there as well.

Chris McAlilly 31:50
I'm sure you know 'Salvation on Sand Mountain." That's one of my favorite books.

Brett McCarty 31:54
Oh, yeah. No, exactly. Exactly.

Chris McAlilly 31:56
If you're interested in in southern Appalachian Christianity, check out that book by Dennis Covington. It's so, so interesting. It's about snake handling. And anyway,

Brett McCarty 32:07

Oh, and it's interesting, the... well, now you've taken me down a rabbit trail. But Robert Orsi, this religious studies scholar in one of his books, writes about "Salvation on Sand Mountain," as does Covington. And Orsi actually says Covington should have taken up snakes and kept going. But there's this moment in the book where, toward the end, where he makes that congregation agai, a cultural other, right at the end of the book, and Orsi, like, presses him. It's so beautiful, so compelling, but you actually, ultimately do the distancing work that you're trying to fight against. But that gets into questions also of what does it mean for me to be a participant observer in these communities? None of which--I definitely was not with any snake handling churches, though some of my research partners knew knew of them. But, you know, this was Methodist, Baptist, nondenominational evangelical types.

Brett McCarty 33:13

And so... Sorry, this question of the power of testimony, though, it's actually like, how does witness enable agency? What does it mean to hear someone's story and realize that there are pathways in front of you of action that you didn't even know existed and that you might actually could walk down those paths because this person did? And somehow it happened. And to hear their testimony enlivens your imagination, enables the Spirit's work, would be one way to think about it theologically.

Brett McCarty 33:52

And I mean, it's even like this is a deep, Christian, theological commitment. I mean, all the way back to Augustine's confessions, if you read carefully, the moments leading up to his conversion in that garden in Milan, he hears all these testimonies, or reads about these testimonies and people testifying to other people's testimonies. All of that is right in the narrative leading up to his conversion. And in a kind of narrative, forceful way it makes possible his turn there in the garden. So yeah, so "they've conquered him by the blood of the lamb by the word of their testimony" is not a verse I've thought about much before but I've been thinking about it a lot since hearing some of my research partners use it.

Chris McAlilly 34:38

Yeah, I mean, this just comes back to this whole conversation about decision making and ethical choice and the stories that we understand ourselves to either be constrained by or that we're living into. And how, I can't remembe. It's probably somewhere in Stanley Hauerwas's work. You can only learn to live in a world that you can see, and you can only see a world that you can say. And there's something about testimony, that hearing somebody else's story does enable you, because you can see a path, you can see a story, you can see a world that allows you to potentially move into it. And then, and that testimony is set within the context of this rich, unconditional love in recovery communities in such a way that you don't only hear the testimony, but you're going to get to work through how your story can be aligned with one of these, you know, in some ways a canned story. It's not... I mean, there are types. "Canned" sounds pejorative, but what I mean is simply that there's a similar kind of art to the narrative, even though there's specificity and concreteness to each individual story.

Brett McCarty 36:02

Yeah, yeah. No, that, that seems right. And it um, I think the way that testimony and these witnesses are making a claim on their audience in the telling of it. It's not just simply some factual account. It's in the hearing of my story, you should consider how you might respond accordingly, to follow in my footsteps in whatever analogous way that might be. But also, and this gets back to the Tuesday evening-Sunday morning crowd, to hear that testimony is to have a claim made upon you by another member of your body that says, "Here I am. Here's what's up with my life. And now we're in relationship if we weren't before. How are you going to care for me?" I mean, they're not saying that necessarily in the testament of but performatively that's what's happening in many ways. And, in some ways, that's why the Sunday morning crowd, we might want to stop up our ears to the testimony because it's making a claim on us to act and live in different ways if we really want to take it seriously.

Chris McAlilly 37:23

That's right. Yeah, that's right. And yeah, I think the hardest thing is to really consider what it means to be a person in the grips of addiction and to consider that that might be you. Or let me just turn it back around and say, to consider that that at times has been me, you know. I was really struck by your description of Helena Hansen's work on Pentecostal drug ministries in Puerto Rico. And one particular footnote in the piece that I read, "Pentecostal conceptions of addiction center on power. Addiction is due to the unconverted individual's vulnerability to malignant spiritual forces." I found that description to be so powerful: the vulnerability to malignant spiritual forces. I wonder if you just talk a little bit about that work and that description, if you don't mind?

Brett McCarty 38:23

Yeah, no. Helena Hansen is an amazing medical anthropologist and psychiatrist who was at NYU, and recently moved to UCLA, and her book "Addicted to Christ," what you were just reading from, is a powerful story of these Puerto Rican Pentecostal drug ministries that were serving particularly Puerto Rican men. And she places her ethnographic experiences with these communities in conversation with the 12 Step programs in the US and other approaches, the medical approaches to addiction and action. And she makes this interesting contrast. And let's come back to your comment about vulnerability.

Brett McCarty 39:13

But she makes an interesting contrast between how both 12 Step programs and very medical, just strictly medicalized accounts of addiction can trap you in a certain social script. So I mean, 12 Step and medical approaches can do so much good, so please don't hear me dismissing them. But sometimes in and of themselves, you know, if I were to say, "Hi, my name is Brett. I'm an addict, and I've been sober for 10 years," there can be a truth telling in that. But then, there also can be a kind of, that's who I am. And that's all of who I am, is an addict who's been one for 10 years or whatever. There's no possibility of a new script, a new path coming out open before you.

Brett McCarty 40:06

And similarly, medical accounts of addiction is kind of a chronic relapsing disease of the brain. That's all that it is. And then you need a lifetime of medical care, kind of just perpetual treatment, because you are defined in a way by this addiction. Now, the wisest folks in the 12 Step community, the wisest folks in medical care, they totally get this, and I'm not trying to keep folks trapped in that old identity, but the power that Hansen draws out in the 12 step, I mean, in these Puerto Rican Ministries is that these Pentecostals believe the Spirit is at work in the world and new stories are possible for folks who've been defined by stories of death.

Chris McAlilly 40:52 Come on. Come on.

Brett McCarty 40:54

Right? And that is, that's powerful. And, you know, there's the danger of self delusion there that you can say, "I'm stepping into a new story," when you're really defined by your old one still, but, I mean, what is the cross and resurrection, if not the possibility of a new story in this world? And that such a story can be testified to by the folks in recovery ministries is something I hope we all pay attention to.

Chris McAlilly 41:33

Yeah, and I think if there is the possibility for new stories to be told, or the Spirit is still at work beyond kind of our story, that then the scripts that are there can be for truth telling. And even when you do get trapped, there is this possibility that you can emerge from it. But I think, you know, one of the things that that you're really driving in the piece that I read on the opioid crisis in particular, is that there really are these not just cultural scripts, or social scripts but really powerful forces at work on our freedom. And you talk about economics, you talk about the criminal justice system, and modern healthcare, each of those deserves its own conversation, and we're not gonna be able to dive into into each of them. But what do you think, of those three, which one would you highlight for folks as being particularly menacing, as folks try to emerge out of opioid addiction?

Brett McCarty 42:33

That's hard. Well, we've talked some about healthcare already. And there's been a lot of work in the criminal justice world about decriminalizing drug behavior, or moving folks out of just cycling them through prison and jail to more rehabilitative approaches, and trauma informed care. So, in some ways, we've touched on both of those. I guess, on the economic front, without meaningful work to do, you know, there's a certain logic by which drug use makes a lot of sense, if your world is pretty bleak, and there's no hope for you moving forward... There's not too much of a difference between the rise, on one level, between the rise of the video game industry and the opioid crisis, because both are offering an escape from attending to reality in front of you.

Brett McCarty 43:47

And I think that the causal reasons underneath that, you know, we kind of joke about 28 year olds in their parents basement, playing video games, but there there are economic reasons for some of that happening. And I think in Appalachia, in particular, you have this deep history of well intended projects, like the New Deal in Tennessee, the TVA, and the creation of national parks that are amazing programs that we talk about with fondness, often. But to make possible some of those lakes and dams and national parks, you basically had to forcibly remove huge swaths of people in their communities.

Brett McCarty 44:34

And some of the way that the government went about doing that was bringing in very sharp sociologists and ethnographers and, well, they wouldn't have said ethnographers back then. But sociologists and photographers and these other folks from the University of Chicago and elsewhere to chronicle a people in need of the government's help. And so you have this kind of invention, almost, of the Appalachian other to justify the government's intervention in removing them from the land that they've belong to for so long and the communities that they've survived within to be relocated, whether in government foster care, or some of thesesimilar impulses, but the kind of forced sterilization eugenics programs. All of that made possible all these nice things that middle and upper middle class folks enjoy. And so I think that economic questions of how to work to enable people and communities to discern and pursue their good and not to simply be subject to the whims of outside forces in their caricature of them is a huge, huge question that is really bound up with a lot of the issues in the opioid crisis.

Chris McAlilly 45:58

I think that brings me back to just the witness of churches and really where you see hope. You know, I think the challenges are very clear and vivid and complex and wicked. And I wonder, for you, maybe an example of a witness of a church that you would point folks to and a place where maybe you see hope?

Brett McCarty 46:24

Yeah, I guess a couple of things come to mind. First, you know, if we aren't willing to face the truth of the difficulties in front of us, if we aren't willing to bear reality, as Stanley Hauerwas would say, then we have to tell the truth about ourselves and the world before we can discern faithful action within it. Or more accurately telling the truth about the world is constitutive of being able to act faithfully within it. And so you have this amazing proclamation from Jesus at the beginning of his ministry in Luke 4, where he reads the Isaiah scroll, and said, "The Lord's anointed me to bring good news to the poor, proclaim release to the captives and recovery of sight to the blind to let the oppressed go free to proclaim your Lord's favor." I mean, it's an amazing moment.

Brett McCarty 47:32

And right there, he's like naming, you know, economic issues with poverty, criminal justice issues with captivity, and healthcare questions with sight to the blind. They're at the very center of his ministry. He's pulling all these threads together in a way and his in-breaking Kingdom is meant to liberate and give life inside of these structures that are dealing death in all those spheres. So that's all by way of not directly answering your good and direct question.

Brett McCarty 48:10

But I think there's a the church that comes immediately to mind that was founded when some folks just started hanging out with people living on the street downtown, and they would invite them to share meals. And out of that birthed this small church whose witness really rippled out throughout the community. So they would worship you know, in this small downtown space, and not have a ton of folks there every Sunday, necessarily, but they'd all share a meal afterwards and their lives--and who is "they" in that sentence? The more privileged folks who helped start the congregation were opening their lives to being claimed by anyone who walked in off the street for a meal that day. And in opening their lives to being claimed, and they did something similar with the day reporting center, and showing up to folks who might be on parole, probation. How might these men and women caught up with the criminal justice system make a claim on me? How can I walk with them?

Brett McCarty 49:27

And in responding to that claim, they became these witnesses in the local region. I mean, they got a federal grant. We're speaking to the huge healthcare system. Like, some national recognition of transformative possibilities in this space, all because they literally just fed someone who was hungry and saw somebody who was on the street without a place to sleep and listened to them and walked with them. And you know there's a fragility to that. I mean, that church actually is not, kind of folded up shop recently. COVID was really hard. And we should talk about that before we finish, about the impact of COVID in all of this. But that doesn't mean that the beauty of their witness wasn't transformative throughout a whole region with some national applications. So I don't know if that's helpful. But that story immediately comes to mind.

Chris McAlilly 50:29

No, it does. It's very helpful. And yeah, we'll have to have you back on and have a whole nother conversation about about the COVID dimensions, because I do think that that's worthy of really diving into with some more depth, but we're kind of out of time for today. I wanted to just ask, if folks want to continue the conversation, if they're interested in kind of exploring some of the work that you do, or some of the initiatives you're a part of maybe where you would point, folks?

Brett McCarty 50:57

Yeah, no, thanks for that. I mean, it's a joy for me to be a part of the Theology Medicine Culture Initiative at Duke Divinity School, where several of us have joint appointments between the School of Medicine and the Divinity School, and we really work to help enable Christians as they intersect with health care, discern and pursue more faithful ways of walking in that space. So we have a program for Christian health care practitioners to come and study with us. And it's such a joy for me to walk with these amazing individuals who come from all over the US and really are seeking to pursue the Lord more faithfully in their local healthcare context. So that's a site. We have lots of resources up on our website, tmc.divinity.duke.edu. And it's just really a joy to work with my colleagues in that program and throughout the Divinity School. It's just, I'm really grateful and would love to be in touch with anyone for further conversation.

Chris McAlilly 51:56
Well, Brett, thanks a lot for being on The Weight today.

Brett McCarty 51:59 Yeah, thank you, Chris.

Eddie Rester 52:02
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Chris McAlilly 52:08

If you would like to support this work financially or if you have an idea for a future guest, you can go to theweightpodcast.com. [END OUTRO]