Recommendation: Honestly, this was a struggle to get through
Read with: I wrote this review tipsy on this – allow me to recommend
In brief: Not to be confused with John Howard’s doorstop memoir Lazarus Rising, Raising Lazarus is Beth Macy’s follow up to 2018’s Dopesick, her widely acclaimed account of the opioid crisis in the United States. Unfortunately, to my mind, Raising Lazarus is more of the same – jumpy structure, lack of narrative drive and difficulty (or lack of interest) in conveying the corporate and government angles. The last is particularly infuriating, given that the Perdue bankruptcy is the touchstone of the whole book.
I read Dopesick some time ago and although it was not, in my view, the best book about the opioid crisis on the market, it was the most focused on individual experiences of the epidemic and the shocking gaps in the treatment options available to people looking to get clean. Raising Lazarus is an expansion on this theme – Macy focuses almost entirely on efforts by activists and treatment providers trying to offer evidence-based solutions in the hardest hit and most conservative parts of America. The struggle to offer Suboxone and needle exchanges in the face of staunch opposition from CAVE’s (Citizens Against Virtually Everything) is a consistent theme in the book, as is the difficulty in convincing police and government to adopt medicalised approaches rather than throwing addicts into either increasingly overcrowded gaols or Jesus-saves, abstinence-only 30 day rehabs.
In keeping with her style, Macy shadows individuals and organisations across years and rarely ventures beyond those stories. This is fine as far as it goes, however it creates what I suggest are the two primary flaws in the book:
- First, Macy totally fails to explain the background litigation and the complexities of the bankruptcy plan proposed by the Sackler family to shield them from civil claims. This is particularly irritating because it is a major theme in the book, with Macy following activists agitating to bring attention to the Sackler’s role in creating the crisis and attempting to stop the bankruptcy deal. The reader is supposed to take as gospel that the bankruptcy plan is evil chicanery by overpaid and unethical corporate lawyers and the cowardly AGs of the various States who support it. That may well be the case, but there is absolutely no attempt to explain the complexities involved or why someone acting in good faith might well see it as the best of a bunch of shitty options. We already know she does not “do corporate” but here the emphasis on the little guy is actually unhelpful in conveying the stakes. And in a narrative almost totally devoid of structure or dates, the progress of the bankruptcy case is about the only metric we have for time – it would have been useful had that been clearer.
- Second, there is (at best) a half hearted attempt to explain why some people who oppose the approach Macy advocates for might have the views they do. I personally enjoy the addition of the term “CAVE” to my vocabulary, but its use can do a great disservice to the those involved. So does the use of the word “stigma” to describe all negative attitudes towards addiction and people who are addicted. There may well be stigma, but the sorts of addiction-driven behaviours Macy describes also leave deep marks on the people affected by them, particularly the behaviours that are, in fact, crimes. A person whose house is broken into constantly, or who has suffered violence and abuse from an addicted person in their life, might well be more “enlightened” if they support evidence-based medical treatment, but anger, frustration, pain or “I cannot afford to give a shit about you anymore” are perfectly understandable reactions that do not deserve to be written off as ignorance. It should be acknowledged that many of Macy’s subjects advocate a “meet them where they are” approach to opponents and addicts equally which she seems to agree with – Macy does, for example, describe challenging one of her subjects’ statements about the necessity of defunding the police to achieve anything. Perhaps this is enough, but I became more and more irked the further I read. Towards the end of the book, for example, Macy cites a statistic that 75% of primary care doctors would not want a family member to marry someone with an opioid addiction as evidence of continuing stigma. This is, with respect, an absurd conclusion to draw from that number alone (the study may provide additional context, but she does not give a citation). Having written two books about how awful addiction can be, how impossible it can be to get treatment and how fraught and tenuous recovery can be, Macy should have more insight than most into the reasons a person might not welcome addiction into the lives of a loved one.
This is a flawed text. I doubt it will convince the naysayers, who will see themselves lumped in with the CAVE who suggested overdose victims should be harvested for their organs rather than given Narcan. And if I, a former corporate litigation/insolvency lawyer (granted, from a different jurisdiction), had no fucking idea what was going on with the bankruptcy case, spare a thought for the lay reader. However, there is no doubt that Macy’s advocacy for the view that addiction is a medical not a moral problem, and her modelling of empathy for the plight of those struggling with addiction, is an important corrective to prevailing wisdom. Raising Lazarus is exemplary in this respect.
Bookshelves & Bourbon 