In addicted.pregnant.poor, Kelly Ray Knight (2015) provides an ethnographic portrait of extremely marginalized, drug-using, and pregnant women living in the daily-rent hotels (referred to as “single room occupancy” housing, or SROs) of San Francisco’s Mission District. Knight asks: “What forms of life are possible here?,” in reference to the women she profiles, their developing pregnancies, and the forms of professionalized, expert help enlisted in their rehabilitation (Knight 2015, 6). The central concern of Knight’s text involves enlisting a detailed account of the complexity of the daily lives of women SRO occupants as they move through a variety of institutional fields, with the greater aim of speaking back to the incomplete, seemingly logically inconsistent, and inaccurate representations of the lives of addicted, pregnant, and poor women as they are depicted in public policy, the scientific imagination, popular culture, and by service providers.

Knight is primarily occupied with interrogating the current state (or lack) of knowledge regarding addiction, mental illness, and “socially condoned motherhood” in the contemporary U.S. (Knight 2015, 7). Her overall argument is marked by a concern with whether or not the constraints faced by the subjects of her text are so contradictory, and so acute, that they preempt the very possibility of survival—both for mothers, and for their children. The text also includes a reflexive consideration of Knight’s own ethnographic voice, and the potential consequences of the politically charged decisions she makes in both serving and representing her subjects, as she executes her dual roles as researcher and service provider.

The voices of the mothers themselves feature prominently in this eight-chapter text, in addition to the perspectives of the individuals and institutions tasked with making truth claims about Knight’s research subjects. The perspectives of public health epidemiologists, community advocates, policymakers, treatment professionals, social service bureaucrats, and social scientists are all included, though primary data is limited to ethnographic observations and interviews with SRO occupants, as well as informal interviews with local service providers. Knight’s argument highlights the problematic distances between the realities of daily life for her subjects, the knowledge claims produced by mental health and epidemiological experts, and the interventions designed to address the women’s suffering. In addition to fieldnote and interview excerpts, Knight also includes analysis of secondary sources to provide policy and historical context. The text includes six substantive chapters, bookended by a standard introduction, conclusion, and methodological and demographic appendix.

Knight begins her narrative with an examination of her subjects’ near-constant state of anxiety regarding moment-to-moment need satisfaction for housing, food, drugs, and safety. The city’s conceptualization of SROs as a housing ‘solution’ for women who are not often sole occupants is contradictory, in that routine public health research on SROs does not often account for ‘visiting’ sex work patrons, cohabiting partners, future infants, or women’s desires to regain custody of their children in state care. Next, Knight considers the overlapping and contradictory temporal anchorings pregnant and addicted SRO residents are subject to: “addict time, hotel time, pregnancy time, jail time, treatment time, epidemiological time, biomedical time, memorial time, and life time” (Knight 2015, 72). Temporal conflicts provide a powerful alternative to explanations for addicted mothers’ seemingly ‘disorganized’ behavior rooted in the ‘culture of poverty.’ A subsequent chapter considers shifts in domestic poverty policy that erected a false partition between addiction diagnoses and mental health diagnoses, which ensured that while mental illness remains a recognized basis for claims to public resources, addiction was excluded, further complicating truth and entitlement claims. This policy reconfiguration worked to empower “neurocrats,” or “advocate(s)-cum–bureaucrats,” that serve as providers and expert knowledge claimsmakers, and promote the biomedicalization of poverty (Knight 2015, 104). The next chapter further traces the entanglements of ‘underlying’ mental illness with women’s substance use, which obscures a holistic understanding and treatment of suffering for service professionals. Further, the mania-inducing impact of unstable housing, the cumulative impact of trauma exposures, and the experience of pregnancy serve to complicate symptomatic presentations, diagnostic possibilities, and resource eligibilities. Next, Knight examines media representations and scientific imaginaries of addicted pregnancy in ‘stratified reproduction,’ demonstrating the inherent tensions between rehabilitation and punishment, coercion and care, fetal rights and mothers’ rights, criminality and victimhood, and the independent, discerning, rational, and self-governing neoliberal subject versus the state-dependent, drug-addicted, ‘welfare queen.’

One of Knight’s primary theoretical contributions involves her reconsideration of the theme of ‘risk’ from both neo-Marxist and Foucauldian perspectives. In doing so, Knight suggests that both perspectives may together play an important analytic role in conceptualizing the seemingly logical inconsistency of her subjects’ simultaneous victimhood and criminality. As a result of this tension, providers are able to make use of both coercive and punitive state apparatuses, as well as bureaucratic discretion in resource allocation and rule-bending, in order to work towards ameliorating the suffering of women who are simultaneously conceptualized as both victims and perpetrators. ‘Risk’ is considered in the context of the pregnancies themselves, in providers’ attempts to intervene, and in individual women’s lives in the ‘risky city’ (marked by marginalization, gentrification, sexual and physical violence, the low-wage economy so untenable and inhumane as to compel sex work) as they try and often fail to represent themselves as self-governing subjects (rendering Knight’s subjects ‘perpetrators’). Moreover, risk is seen as part of the overall picture of public health in the neoliberal era, marked by state retreat from mitigating risk for citizens (rendering Knight’s subjects ‘victims’). Most significantly, Knight interrogates risk by asking whether statistical and biomedical renderings of addicted, pregnant, and poor women somehow work to normalize the inevitable human suffering and loss of life in contemporary urban spaces that results from market fundamentalism and neoliberal policy shifts. This is perhaps the most powerful theoretical, epistemological contribution of the text. Also noteworthy is Knight’s rendering of the social construction of time, in that she provides a sophisticated portrait of the dire consequences of her subjects’ experiences with multiple and conflicting temporal logics.

Audiences with potential interest in Knight’s work include researchers from a number of disciplines studying urban marginalization; homelessness/housing insecurity; violence and the cultural ‘genealogy’ of trauma; drug addiction; public health; the politics of motherhood, reproduction, and natalism; and disability/mental health; as well as students taking either advanced undergraduate or graduate seminars in medical anthropology, law and policy, urban anthropology, crime, and public health. Additionally, a good portion of the text is written accessibly enough to maintain benefit and appeal for service providers who may have contact with similar populations.

Danielle Docka-Filipek, Christopher Newport University

Knight, Kelly Ray. Addicted.pregnant.poor. Duke University Press, 2015.  Read more at Duke University Press