Angela Garcia

Department of Anthropology
Stanford University (E-mail: garcia2@stanford.edu)

Serenity: Violence, Inequality, and Recovery

on the Edge of Mexico City
Over the last decade, there has been a sharp increase in drug addiction in Mexico,
especially among the urban poor. During the same period, unregulated residential
treatment centers for addiction, known as anexos, have proliferated throughout
the country. These centers are utilized and run by marginalized populations and
are widely known to engage in physical violence. Based on long-term ethnographic
research in Mexico City, this article describes why anexos emerged, how they work,
and what their prevalence and practices reveal about the nature of recovery in a
context where poverty, drugs, and violence are existential realities. Drawing atten-
tion to the dynamic relationship between violence and recovery, pain, and healing,
it complicates categories of violence and care that are presumed to have exclusive
meaning, illuminating the divergent meanings of, and opportunities for, recovery,
and how these are socially configured and sustained. [addiction, violence, Mexico,
drug war, informality]

In a working-class barrio on the edge of Mexico City is a placea room, really

called Serenity (Serenidad). Serenity is located in a two-story concrete building set
behind a gated patio. Its about 20 by 15 feet, with greyish-green walls cluttered
with handwritten schedules, rules, and slogans: 5 AM: Get Up! Do Not Touch!
Live and Let Live! The ceiling is stained from water; the tile floor is cracked. Two
windows are covered with paper and iron bars, and the odor of feces, bleach, and
rotting fruit hangs heavily in the air. Yet the room is tidy, even cleanits tattered
chairs are neatly stacked, the worn floor shines.
Fourteen men and two women live at Serenity. They are self-described alcoholics,
drug addicts, schizophrenics, neurotics or, more simply, los anexadosmeaning
those living in an anexo, which is what Serenity is. An anexo (annex) is a hybrid
institution composed of parts 12-step program, mental asylum, prison, and church.
Run and utilized by Mexicos working poor, anexos are concentrated in areas
affected by drug-related violence and they utilize a form of violence as care to
treat drug addiction. Families pay anexos between 250 and 450 pesos a month
(approximately 2035 U.S. dollars) to intern their relatives for months or years.

MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 29, Issue 4, pp. 455472, ISSN 0745-
C 2015 by the American Anthropological Association. All rights
5194, online ISSN 1548-1387.
reserved. DOI: 10.1111/maq.12208

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456 Medical Anthropology Quarterly

They do this not out of ignorance or neglect but because anexos are the only source
of care available to them.
Luis, a 29-year-old schizophrenic, has lived at Serenity for seven years and says
hell probably never leave. Eighteen-year-old Bobby is addicted to crack cocaine;
hes lived there for just under one year and worries about the day he will have to
leave. They both tell me that the violence they suffer, conceived here as treatment,
is nothing compared to what they know or imagine to be waiting for them outside.
Luis explains, I learn about the outside from the others. Its a terrifying place. I
am not afraid here, only tired. And Bobby: Yes, I miss my freedom. But there
are more people outside who want to kill me than protect me. Hopefully, they will
forget about me before I return.
In this article, I offer an ethnographic examination of anexos, which have quickly
become Mexicos foremost institution for residential drug treatment. Based on long-
standing fieldwork in Mexico City, I describe why anexos emerged, how they work,
and what their prevalence and practices reveal about the nature of recovery in a
context where poverty, drugs, and violence are existential realities. By examining
an alternative therapeutic space where the work of recovery is sometimes supported
by violence itself and where physical pain potentiates healing, I illuminate the di-
vergent meanings of, and opportunities for, recovery and how these are historically
and socially configured. This article joins recent anthropological discussions about
the interplay of violence and care (Garcia 2014; Stevenson 2014), the effects of ne-
oliberal health reform in Latin America (Han 2012), and the uncertainties of illness
and everyday life among the working poor (Auyero 2012).
By taking as its central concern how anexos are enmeshed with the precarious
stance of the poor, this article also reassesses taken-for-granted categories of pain
and recovery. For instance, in the realm of secular biomedicine, pain is clearly delin-
eated as a biological problem to be avoided or alleviated, and the idea of inducing
pain as an instrument of recovery perceived grounds for ethical concern (Morris
1991; Norris 2009). However, in anexos, the domains of violence and recovery,
pain and healing are not conceptually distinct but are folded into each other in
culturally salient ways that are expressive of everyday life. Practices like prolonged
kneeling on bottlecaps, holding weights with outstretched arms, and being deprived
of sleep and food are common in anexos and embody a Roman Catholic sensibil-
ity that conjures sacrificial pain. Other practices, like mock abductions and forced
confinement, reflect Mexicos ubiquitous criminal violence and may suggest cruelty
and lawlessness. Considered together, these practices pose the challenging question
of what forms of analysis and description are best suited to understand the complex
ways violence is enmeshed in processes of recovery and how pain may be a genuine
sign of recovery itself].
Human rights organizations disapprove of anexos and have unequivocally called
them abusive, ineffective, and unethical (International Drug Policy Consortium
2014; Jurgens and Csete 2012). They have focused almost exclusively on procedural
concernsinformed consent, legal code, and administrative and clinical conduct
ignoring the context in which anexos are immersed and the ethical relations that are
formed within them. Such perspectives have led to a troubling disconnect between
the ideals of addiction medicine, human rights and bioethics, and the everyday real-
ity of local worlds (Kleinman 1999; Petryna 2005). In Mexico, this disconnect has
 Violence, Inequality, and Recovery in Mexico City 457

led to the indiscriminate condemnation of anexos and the families and communities
that comprise them. Indeed, the sparseness of scholarship on anexos from other
perspectives is perhaps indicative of the power of liberal discourses to exacerbate
the very marginality of populations it establishes as such.
My approach to anexos range of practices is to be sensitive to contextual nuance
and their particular gestures and narratives. My aim is not to subject them or their
practitioners to moral scrutiny or clinical assessments but to read their cultural
logic and to understand the disparate form of recovery and sociality they produce.
The view of anexos as embedded and encumbered by larger historical and social
processes is fundamental to such an endeavor. I trace these processes with the goal
of helping us appreciate the concerns of people working and living in anexos and
the families that have come to depend on them. Using ethnography, I open up new
ethical, anthropological, and political questions, including to whom does ethical
and effective treatment belong? How might recovery be achieved, not in terms
of the liberation from pain for an individual body, but in terms of the painful
relationships one makes with others? To pursue such questions, some basic context
on the growth of addiction, violence, and public health retrenchment in Mexico is
necessary.

Basic Necessities
Over the last decade, Mexico has transitioned from being mostly a drug transit
country to now also being a user country. Epidemiological surveys have indicated
a sharp increase in addictions in the past 10 years, especially in poor urban settings
and along Mexicos border with the United States (Encuesta Nacional de Adicciones
2012). In Mexico City, crack cocaine is responsible for the highest increase in
addiction among the poor and working classes. Hidden populations of people with
addictions, particularly on the urban periphery where drugs are often a means of
survival, are known to exist but are generally not included in these studies.
In 2011, Mexico introduced substance abuse treatment into its public health
insurance program known as Seguro Popular, which debuted in 2003. Although
on paper the plans coverage is extensive, much of the country still lacks the public
infrastructure to implement addiction treatment, let alone primary and mental health
services (Homedes and Ugalde 2006). Fewer than 10% of Mexicans in substance
abuse treatment receive government-funded treatment, making 12-step and religious
mutual aid groups the principal source of addiction treatment in Mexico (Marn-
Navarette 2013). Public health experts estimate that 90% of Mexicos residential
treatment for addiction for the poor is provided by anexos.
The presence of anexos in Mexico City reaches back to the mid-1970s. Their
development is related to the establishment of Mexicos 24-Hour Alcoholic
Anonymous groups, which represented a breaking away of many Mexicans
from traditional Alcoholics Anonymous (AA). As Stanley Brandes notes, AAs
extraordinary growth in Mexico, especially among working-class Catholics, defied
assumptions about it being culturally tailored to a white, Protestant middle class
(Brandes 2002). Yet, Mexicos 24-hour groups grew out of what its founders called
the necessities of our country, including the socioeconomic characteristics . . .
of marginal alcoholics (Grupos de 24 Horas 1990:2). These groups embraced a
458 Medical Anthropology Quarterly

religious and confrontational sensibility and offered anexos, where poor, homeless,
and chronically ill alcoholics could stay while sobering up (Rosovsky 2009). While
many 24-hour groups remained aligned with traditional AA, others differentiated
themselves further by intensifying their confrontational style. Endeavoring to
provide long-term residential alcohol and drug recovery services for the poor, these
offshoots of the 24-hour movement became widely known as anexos.
Anexos are sometimes compared to Synanon, a drug-free therapeutic commu-
nity that rose to prominence in the United States during the 1960s and 70s. The
comparison is understandable given the shared emphasis on the therapeutic value
of confrontation and long-term residency (Yablonsky 1967). However, there are
significant differences between the two programs.
Synanon used verbal, not corporeal, confrontation as a mode of therapy. It
appealed to socially and economically diverse populations, most of who joined
the program willingly and with the goal of personal transformation. The program
emphasized individualistic explanations for addiction and sought to cultivate self-
reliance as a path toward clean living and self-actualization. Despite consider-
able controversy, Synanon was widely praised by social scientists and clinicians for
successfully rehabilitating people with substance abuse problems (Janzen 2001).
In contrast, Mexicos most marginal populations utilize anexos. Participation
is usually coercive and involves therapeutic violence as a mode of personal salva-
tion and communitarian survival. Finally, most clinicians and the broader Mexican
population view anexos as abject and criminal. Serious scholarly engagement with
anexosto understand the mechanisms for their production, the burdens they carry,
and the therapeutic logics within themis needed. Such work is all the more im-
portant as poverty and rates of addiction increase in Mexico and as the numbers of
anexos grow in other parts of Latin America (Wilkinson 2013).
At the most basic level, anexos are informal, unregulated, and destitute. They
tend to be concentrated on the peripheries of cities or in impoverished rural areas,
where they are called granjas (farms). To varying degrees, these areas lack basic
public infrastructure, health and social services, and legal sector jobs. Drugs are
often a means of survival and may even make life more habitable, but they also pose
tremendous risk.
Anexos are usually composed of one or two rooms where dozens of anexados are
confined and subjected to a mix of interventions. Treatment usually lasts three12
months, although longer and shorter stays are frequent. Hierarchical in structure,
anexados who have achieved longer periods of staying clean and sober are called
encargados (the ones in charge), and they monitor newer anexados. Many encarga-
dos move on to become padrinos (godfathers or sponsors), the term for the founders
and leaders of anexos.2
In the anexos I observed, anexados lived and performed all of their activities in
the same room, at the same time, day after day. In addition to sleeping and eating,
activities include exercising, praying, meetings, talking, cleaning, counseling, and
participation in collective or individual therapeutic violence. The majority of ones
time in an anexo is spent sitting in 12-step meetings (juntas).
Maintaining elements of traditional AA meetings (e.g., working the steps,
reciting the Serenity Prayer), anexos meetings last for several hours every day, or
are held multiple times a day. During them, anexados offer and listen to testimonies
 Violence, Inequality, and Recovery in Mexico City 459

(historiales or compartimientos). Testimonies concern issues often shared in the

recovery setting, like family violence, broken hearts, poor health, and feelings
of hopelessness. They also frequently describe harrowing experiences with drug-
related violence, including kidnappings, forced disappearances, and homicide. A
single testimony can last two hours or more, and is usually accompanied by yelling,
weeping, and long stretches of silence. It often ends with the testifying anexado
being embraced by peers. Anexados described healing experiences from meetings,
including feeling forgiven, understood, or relieved, and developing trust and the
desire to help others. Such experiences resonate with anthropological accounts of
healing through sharing narratives of suffering (Csordas 2002; Garro 2003).

Setting and Methods

Mexico is a large and varied country, and this study describes only a part of its
system of addiction services. It focuses on anexos within Mexico Citys greater
metropolitan region, an area of more than 21.2 million people. In Mexico City, I
visited and observed over 20 anexos and spent a total of 12 months, over a period
of three years, observing Serenity, the anexo described in this article. Fieldwork
involved at least 45-day-long (6 am to 9 pm) observations to become familiar with
Serenitys routines and rhythms. Shorter observations focused on understanding spe-
cific activities and labors within anexos, such as meetings and mealtimes. Archival
research on relevant historical and socioeconomic issues and surveillance data pro-
vided context for understanding the conditions under which anexos emerged and
exist.
Respectful interaction with padrinos was essential to gain support for this study,
especially given the hierarchy within anexos and the stigma that surrounds them.
I interviewed padrinos in each of the anexos I observed, including roughly 10
extensive audiotaped interviews with the padrino of Serenity. Due to concerns
about safety and confidentiality, I used observations and informal conversations,
not one-on-one interviews, to gain information about anexados lives. I conducted
audiotaped interviews with 13 anexados, including four women after they departed
Serenity, and 10 families granted me interviews in their home. I also interviewed
health care professionals and government officials, all of whom were highly critical
of anexos. However, most recognized the lack of alternative residential treatment
options for the poor.

Making the Margin

There is no definitive history of anexos. Thus, the history provided here, based on my
own research, is provisional. Drawing on this material, I propose that anexos expe-
rienced two significant periods of growth, the first occurring in the early 1980s, thus
coinciding with Mexicos economic crisis and decentralization. These simultaneous
processes manifested themselves in the first international debt crisis of the neoliberal
era (Harvey 2006). Mexicos foreign debt and devaluation were extreme, as were
the measures taken to overcome them. As a prerequisite for loans to Mexico, inter-
national financial institutions mandated privatization of state-owned industries and
free trade. They also prescribed austerity measures, including drastic cuts to public
460 Medical Anthropology Quarterly

health and welfare programs. While such measures helped restore the economy on
a macro-level, wages dropped and inflation increased, leaving more than half of
the total population unable to meet basic needs (Gonzalez de la Rocha and Latat
1991).
In the mid-1990s, Mexicos peso lost 50% of its value against the U.S. dollar,
and rates of unemployment and poverty skyrocketed (Samaniego 2009). In 1994,
the North American Free Trade Agreement (NAFTA) went into effect, which dereg-
ulated the international movement of money, capital, goods, and services between
the United States, Canada, and Mexico. A large and growing body of research
has demonstrated that NAFTA resulted in severe job displacement, rising income
inequality, divestment in public services, and militarization of the U.S.Mexico
border (Alvarado 2008). Other studies have linked NAFTA to the increase in pro-
duction, consumption and trafficking of drugs, and the rise of drug-related violence
in Mexico and the United States (Ciccarone 2009; Rodrguez Gonzalez 2012).
Mexicos reforms exacerbated longstanding inequalities, severely affecting the
lives of the poor and working classes, migrants, and indigenous communities. At
the same time, it has been a crucial force in the production of new forms of survival
and sociality. These two valencesdepletion and productioncharacterize the ex-
pansion of Mexicos illegal or informal services and networks from the 1980s
onward. From drug trafficking organizations to protection rackets to anexos, they
serve a vital purpose in the everyday survival of Mexicos poor. They also index
ongoing insecurity, as they are tethered to extreme deficiencies in the provision of
basic public services as well as to organized crime and violence. Understanding the
lived aspects of illegality requires logic beyond legality itself. This becomes especially
clear when we consider the constitutive role of the drug war in the second wave of
anexos expansion.

War and Neglect

Since December 2006, when former Mexican President Felipe Calderon waged war
on drug traffickers, at least 120,000 people have been killed, 26,000 disappeared,
and at least 250,000 have been displaced, orphaned, or exiled (Molzahn et al. 2013).
The drug war, or la guerra (the war) as it is called in Mexico, has culminated in a
scale of violence and catastrophe unseen in the history of modern prohibition.3
Criminal violence committed by state authorities and cartels is pervasive through-
out the country, and there is a pervasive understanding that the very authorities one
might turn to for protection are likely to worsen things (Gibler 2012). This unset-
tling ambiguity adds to the atmosphere of insecurity, the consequences of which are
social and psychological.
Despite the proliferation of research into the mental health consequences of
armed conflict, violence, and exile across the globe, few studies have explicitly
focused on the effects of the drug war on the psychic lives of Mexicans. Perhaps this
is because the vast body of literature on the drug war has primarily viewed violence
through the lens of criminality, not victimhood. The striking disconnect between
criminality and victimhood in Mexico conceals and perpetuates the suffering of
Mexicans, especially those living in areas where the conflict is most intense.
 Violence, Inequality, and Recovery in Mexico City 461

Drawing on the limited data that do exist, it is clear that the war is taking a
psychological toll. A national survey reported significant increases in depression
and anxiety between 2002 and 2005, years in which drug-related violence was a
serious problem, but not nearly as severe as it is today (Bello et al. 2005). More
recent studies demonstrate sharp increases in mental illness among children and
adolescents (Espinola-Nadurille et al. 2010; Torres Fernandez et al. 2011). Together,
these studies suggest that emotional suffering caused by the war is widespread and
growing and is likely to increase the incidence of associated complications, including
substance abuse.
Despite the seriousness of these concerns, only 2% of Mexicos total budget for
health is allotted for mental health care, 80% of which is used in the operation
of public psychiatric hospitals (Berenzon Gorn 2013), which Mexican and inter-
national advocacy organizations alike have called inhumane, dangerous, and life
threatening (Rosenthal 2010). The majority of patients in these hospitals are aban-
donados (abandoned), meaning they have no family or community able or willing
to support them. Most facilities lack public records or legal review of the placement
of patients in institutions (Rosenthal 2010). It is unclear how many patients are
truly abandoned as opposed to displaced by the effects of extreme poverty or the
devastation of the ongoing war.
What is clear is that Mexico lacks the infrastructure required to respond to the
rise in addiction and mental illness. In regard to addiction, there are an estimated
500 certified alcohol and drug rehabilitation centers in Mexico. Certification re-
quires meeting the standards for residential establishments as articulated in a health
care reform act passed by the Mexican legislature in 2009, known as NOM-028.4
These standards include specific facility and procedural requirements, availability of
professional medical and psychosocial treatment, and respect for the human rights
and dignity of patients. If treatment centers violate these guidelines, the munici-
pal Health Protection Agency is obliged to notify state or federal authorities to
initiate administrative and/or criminal proceedings against the responsible party.
Widespread corruption at all levels of governement make it easy for the leaders of
anexos to pay off local authorities to avoid potential conflict (Nieto 2012).
In contrast to the small number of certified programs, the Ministry of Health
estimates that there are 1,0004,000 anexos in Mexico City. This dramatic range
points to a significant gap in knowledge about the epidemiology of addiction and the
availability of health services for Mexicos among poora gap that propels anexos
growth. Meanwhile, anexos are a regular news item in the Mexican press, where
they are referred to as carceles (prisons), campos de concentracion (concentration
camps), or basureros (garbage dumps). These articles focus on the incidences of
violence that have occurred within anexos without addressing the violence that
surrounds and sustains them.
Violence is indeed widespread in anexos, and deaths are known to have occurred
in them. Most notably, on September 2009, two anexos in Ciudad Juarez were sites
of brutal massacres, which left 28 people dead. On June 2010, six people were
killed in an anexo in Ciudad Chihuahua. In response to these events, government
officials alleged that drug cartels use anexos as hiding places and that the people
killed in these attacks were criminals (Zamudio 2010). Such framings, which have
characterized much of the public discourse about the loss of life due to the war,
462 Medical Anthropology Quarterly

distract from the urgent questions anexos present. They also elide the pressing
concerns poor families face when they must make decisions about how to care for
addicted or mentally ill relatives in the context of extreme violence, poverty, and
scarcity of services.

A Painful Place
The anexo Serenity is located in Iztapalapa, one of Mexico Citys 16 boroughs.
Roughly 21% of Mexico Citys population resides in Iztapalapa, two-thirds of
whom meet official standards of marginality, which are manifested in malnutri-
tion, illness, violence, addictive problems, and family dissolution, among other
conditions.5 Many residents I interviewed more pointedly described these condi-
tions as pain.
The pain in Iztapalapa is palpable and dramatic, and it often challenges a
liberalized sensibility that shudders at willing and elaborate engagements with
suffering. For instance, during Holy Week, thousands of Iztapalapans enact and
identify with the Passion of Christ. The ever-increasing realism of this collective
rite of agonywhich includes very young penitential Nazarenes carrying massive
wooden crosses, the bloody scourging of Jesus, the emotional wailing of Mary, and
the crucifixion itselfis both theatrical and real. In recent years, it has garnered
media attention and criticism for becoming too commercial and violent (Trexler
2003; see also Lomnitz 2005). But the transformations in Iztapalapas passion
play, which has been performed annually since the mid-19th century, extend far
beyond questions of dramaturgy or consumerism. Today, it serves as a staging
of the agony that stems from the violence of the drug war. Many participants
carry large Xerox copies of murdered or missing relatives, and crowds gather to
hear speeches denouncing violence. This is not to say that the passion has become
a political performance, but that the self-inflicted pain that is willingly endured
cannot be experienced without reference to the pain of the war.
Mexico is a wounded country, a country in pain. But it is also a country that seeks
to represent and re-signify this pain. Cristina Rivera Garzas (2011) book Dolerse:
Textos de un pas herido (To Be in Pain: Texts from a Wounded Country) offers
another powerful example of Mexicans engagement and rendering of the violence
and pain of contemporary life. Addressing the consequences of war from the intimate
sites of the individual, family, and neighborhood, Rivera Garza seeks to mold the
language of her text with the force of pain itselfto produce what she calls textos
dolientes (texts in pain). Like the Catholic flagellants mourning Christs crucifixion,
her text emphasizes the singular and embodied nature of Mexicos pain, which is
too often rendered in the Mexican and American imaginary as de-individualized
and disembodied. She writes:

De ah la importancia de dolerse. De la necesesidad poltica de decir tu me

dueles y de recorrer mi historia contigo, que eres me pas, desde la
perspectiva unica, aunque generalizada, de los que nos dolemos. De ah la
urgencia estetica de decir, el mas basico y tamben en el mas desencajado de
los lenguajes, esto me duele.
 Violence, Inequality, and Recovery in Mexico City 463

[Hence the importance of being in pain. The political necessity of saying you
pain me and of taking stock of my history with you, you are my country,
away from the singular, though generalized, perspective of we who are in
pain. Hence the aesthetic urgency of saying, in the most basic and also the
most disjointed language possible, this pains me (emphasis in the original)].6

For Rivera Garza, writing provides a space of contemplation in the context of

brutality. She does not suggest contemplating pain as a means of ridding it. Rather,
she seeks to create an ethics and aesthetics of engaging and representing pain in
which there are, of necessity, traces of violence and wounding. This is the ontology
of Mexico, she argues, un pais herido. Rivera Garza invites her fellow Mexicans,
who are also living in dolor, to engage their pain so that the isolating violence of the
war can pass into something that is shared and put in motion. She does not claim
that such work will necessarily motivate nonviolence, but that it has the potential
to prepare the subject to live againnot without pain but with pain that invites us
to visualize another life, one fully implicated with others.
The ethical significance and potentiality of pain that Rivera Garza presents res-
onates with what I observed at Serenity. There, pain is enmeshed in a search for
recovery. That is, the pain inflicted through anexos use of violence seeks to shift
anexados prevailing relationship of violence to death, or rule of law, toward vio-
lence to life. Emphasized in this transfer is the subjects ability to experience pain
that joins together life in its most intimate and vital sense with the recognition of
the very annihilation of life. These two intensities are kept in reciprocal tension to
shift open a different way of living.
The context in which this occurs is more than just coercive, it is also commu-
nal. Indeed, the very existence of the anexo is a testimony to shared suffering. The
offering of testimonies, group practices of physical discipline, rituals of introspec-
tion, and daily living play out in shared space. While not everyone experiences such
closeness as an instrument of communal bonding, the anexo underscores the reality
that ones struggles and pain are not entirely ones own, nor are they invisible to
others.

Borderlines
Like most of the padrinos I interviewed, Serenitys padrino moved from living in
poverty, to low-level drug dealing, to drug addiction, to internment at an anexo. The
padrinos journey is a constitutive part of the distinctive environment so many Mex-
icans navigate today, and it brings to light complex realities, political and economic
interests, beliefs, and transformations of subjectivity. This article focuses on the
narrative of Serenitys padrino to better understand this constellation of forces and
to help perceive anexos as embedded within the fabric of contemporary Mexican
society. First, let me comment on padrinos general framework of recovery. Like all
therapeutic paradigms, this framework is not always explicit or consistent. Never-
theless, there are some common themes grounded in padrinos personal experience
that can help guide the narrative that follows.
During interviews, padrinos often described harrowing personal experiences of
violence, pain, and deathexperiences thoroughly integrated into their thoughts
464 Medical Anthropology Quarterly

about recovery, healing and life. For example, they often described drug addicts as
medio muerto (half dead), an expression denoting the imminent danger faced by
those addicted to drugs in a context where drugs feed war. Padrinos said confinement
in an anexo prevented death from addiction or drug-related violence. Accordingly,
the first step of recovery is interning the addict in an anexo. This step is arranged,
and thus performed, by family.7 Indeed, families said they placed their relatives in
anexos a prevenir la muerte, a vivir (to prevent death, to live). One father who
committed his adult son described, I love my son but I cannot save him. So I must
either abandon him or send him to an anexo. . . . I sent him to an anexo because I
love my son.
Although such statements may sound similar to the mainstream discourse of
tough love, the underlying logic is significantly different. In the United States, tough
love emphasizes the rights of family members with troubled relatives; it encourages
families to stop helping so that their relative may learn lessons of autonomy and
independence, thereby enabling recovery. In contrast, Mexican families turn to
anexos without reference to rights, but with the compelling claim that there is no
other option but abandonment or death. In this context, committing a relative to an
anexo is an expression of ongoing responsiveness to kin. This could be interpreted
as a sort of tough love, but its conditions of possibility are more urgent and its
execution more severe.
Coercive treatment is hardly new in addiction and is perhaps most understand-
able in the context of endangered life.8 However, unlike the private, military-style
boot camps utilized by many American families with troubled teens, anexos have
been condemned as criminal. This negative construction is not merely due to the
poor conditions of anexos or the lack of education and professional training of
those who work in them. It is also the proximity of some of their practices to forma-
tions of narco-violence. Yet, like any healer, this proximity is the incorporation
of experience and knowledge of padrinos within their own cultural context. Today,
this context is the drug war.
Consider the practice of getting someone to an anexo, which often takes the
form of abduction, with subjects wrapped in a blanket (encobijado). In the lexicon
of the drug war, encobijado (literally, to wrap in a blanket) refers to a way of
disposing bodies. In the anexo, it dramatizes this reality, reinforcing an already
existing fear of being disappeared or killed. especially for young anexados. Older,
more experienced anexados, on the other hand, knew they were being delivered to
an anexo. (As one man explained, The narcos wrap you up after youre dead.)
The anexos incorporation of this practice cannot refuse complicity with violence;
however, in this context, this practice possesses therapeutic value. It constitutes the
revelation of survival, and even of being cared for and connected to others.9
At this point, Id like to introduce the leader of Serenity, Padrino Francisco.
Like many padrinos I came to know, Francisco left school as an adolescent to
work and help support his mother and two younger brothers. For years, he walked
Iztapalapas streets, working as one of Mexico Citys ubiquitous crying vendors. He
sold ice cream, fruit, shoes, and wateranything that people needed or wanted to
buy. Coming of age during the growth of Mexicos drug economy, he eventually
added drugs to his list of goods. In his twenties, Francisco worked for a major
trafficking organization, overseeing the operation of several tienditas (small drug
 Violence, Inequality, and Recovery in Mexico City 465

retail outfits). Although the work afforded him a degree of material comfort, it was
dangerous and stressful, causing him to drink excessively. By his late thirties, he
was, in his words, un perdido muy perdido (a very lost person).
Franciscos brothers were killed in the drug war. Senora Mariana, Franciscos
mother, called them innocents, meaning they were not involved with drugs or
crime, like her son Francisco. Still grieving, she hired someone to kidnap Francisco
and take him to an anexo because she didnt want him to die, too. A single mother,
her siblings migrated long ago to the United States and her parents were dead.
Senora Mariana feared her sons death as well as surviving alone.
For several months, Senora Mariana scrambled to meet the anexos monthly
fees. She took on extra evening work cleaning a movie theater located near Mexico
Citys airport, a job that put her in harms way as her bus was robbed repeatedly.
Still, she described her hardship as a small price for keeping Francisco safe in the
anexo. After successfully completing one year of treatment, Francisco remained at
the anexo, training to be a padrino. Today, he leads the very anexoSerenity
where he was once anexado. His journey guides the aspirations and paths of other
anexados, a process that partly explains the growth of anexos.
Anexados family members are often invited to weekly visits and group cele-
brations, but rarely participate in the day-to-day activities of the center. However,
Senora Mariana became an assistant to her son, as well as a madrina (godmother)
to his charge. Her work at Serenity provided her with a sense of purpose and a
place to reflect on her own struggles. Indeed, a number of mothers described how
their connection to an anexo, which initially stemmed from an interest in helping
their children, became an important resource for them, either by providing a space
to address their own problems or by generating a modicum of income.10 Research
has shown that poor womens involvement in community health services facilitates
the expansion of the traditionally private role of motherhood to new domains,
contributing to increased independence and decreased isolation (Napolitano 2002;
Schneider 2010). At this point, it is unclear whether womens involvement in anexos
will follow suit, but these accounts should be considered when accessing anexos
complexity and value.
Senora Mariana was present during many of my interviews with Padrino Fran-
cisco. During one of these, he reflected on his early days at Serenity, when he was
anexado. It was just after 9 am, time for physical therapy, which meant lifting
weights made out of cement-filled cans and running in place. As the anexados
exercised, Padrino Francisco recalled:

The first day they shaved off all my hair. They were rough on me . . . cut
me. . . . I couldnt wear a shirt for the three months. I was angry and
hungry. I thought, I am in hell, I am in fucking hell! I had to lie down, my
face on the floor in the center of that room. I was a fucking ashtray. They
put their cigarettes out on me. If I moved or yelled they kicked me. . . . I
learned to be still.

During his first weeks at the anexo, Francisco had a recurring vision: He believed
his father was there, beating him. Francisco had not seen his father since he was
a young child, but his visions felt so real that he called out his fathers name. He
466 Medical Anthropology Quarterly

eventually attributed these visions to his many unacknowledged resentments. He

said he gradually became aware of these resentments through therapeutic practices
that recalled their very source: violence.
What follows is an extended fragment of my interview with Francisco. I share it
in edited transcription form because it more effectively opens up the experiential and
ethical complexities of the violencepainhealing relationship that characterizes the
anexo. Such complexity cant be revealed through the narrative of one individual;
various accounts of anexados are needed for a more complete picture and analysis.
Nevertheless, because of my interest in the workings and growth of anexos, my
focus is on Padrino Francisco. I begin about one hour into our conversation, with
his response to my question about what therapeutic violence entails.

PF: You want to know how we hurt people?

: No. I mean, I want to know how you help people.

PF: It is the same thing. The same.

: What? But how do you know that?

PF: Listen, no one gives a shit about these people. But were here. 24 hours a
day, day after day. Were the only fucking ones.

: But all people talk about in the news is the violence and how recovery
cant occur in a situation like that. That what goes on here isnt helping.

PF: So you wash in cold fucking water. Everyone cries, But its cold water!
Fuck, its water! So you sleep on the floor. Its a floor, not dirt! Two tortas a
day, a soup. Nobody here is eating trash. . . . Those idiots dont know shit.
Have them come to a meeting so you can teach those idiots about violence,
OK? . . . Yes, yes, its true. Anexados are fucked up by violence. But that
happens way before they get here.

: But, why hurt someone who is already in so much pain? How does that
help?

PF: Look, people come here out of control. The alcohol, the drugs, the
fucking madness. Were the only ones that help these people.

Senora Mariana: Its true. I knew the stories and I was scared. But there was
nothing else. I tried, but there was nothing. Nothing! So I prayed to St. Jude.
I worked very hard to make this life possible for him. I didnt throw him
away like trash. I didnt abandon him.

PF: This is something people dont like to believe. Why? Because its easier to
think we are all a bunch of fucking criminals. But it is very hard work here.
Do you think I just sit here all day. . . . No! Everyday I share my life, my
 Violence, Inequality, and Recovery in Mexico City 467

emotions, my pain. Its fucking exhausting. But they [anexados] cant just
take, take, take. They have to admit all the terrible, disgusting things they
have done and that have been done to them. Thats why we have meetings.
Thats why we have the steps [12-steps]. But no one wants to do this work
when they get here and if it is too easy its bullshit. Believe me, I know the
difference. You need to go deep and let it out. Deep! Let it out! . . . We know
your shit and we will make sure you know it so that you can move on. Say, I
am sick and disgusting but I can be a better father or mother, a better son. I
am not a fucking rat in the street. My wife is not a whore. So, am I going to
live or die today, or what? The thing is, its a spiritual process. Our job is to
help you through the process, so you can choose the right way. But you cant
do this if you dont see the difference between living and dying. So we need
to be strong with these people. The thing is, violence can be very effective.

: To help people see the difference?

PF: Exactly! So they can choose! It took me a long time to understand this
because I had so many resentments. They were very hard on me. They hurt
me. But one day I began to see things about myself. I understood I was sick
and why I was sick. Not just drugs. Everything! Everything! But it takes time
to understand this.

: When you understood this did they stop hurting you?

PF: No. You need the pain to understand.

: Why?

PF: Because life is fucking hard.

Padrino Francisco capped our lengthy discussion by removing his shirt. He

showed me his back and chest, which were covered with small, crescent-shaped
scarshis cigarette burns from the days he was anexado.
Nothing can be experienced more immediately than the sensations of ones own
body, and if the mark is indelible . . . it is ever-present, writes Roy Rappaport
(1999:148). Indeed, against the many tattoos acquired during his youth, Padrino
Franciscos scars seemed to convey the continuous and embodied nature of his
pain, as well as his recovery. Such indelible marks convey an awareness of the
threatening world in which one lives and dies, and are also a means of responding
to it. Constituted in and through violence, Padrino Franciscos scars represented the
truth of his recovery. Shirt off, smoking, he explained, It is what makes it so
effective here. You feel like you are dying. When you go through treatment here you
feel your death. We make sure you feel it. We bring you this close. He created a
narrow space with his thumb and index finger and held it in front of my face. The
smoke from his cigarette burned my eyes.
468 Medical Anthropology Quarterly

Pain against Pain

There is a rich anthropological literature on ritual ceremonies that involve physical
and psychological pain (Bloch 1986; Rappaport 1999; Turner 1967). These include
studies of the sacred Sun Dance, which is performed annually by a number of North
American Indian tribes and involves the enactment of captivity, torture, and release.
Among its many interpretations is that the ceremony draws on historical trauma
and loss for the purification of the self and good of the community (Jorgensen 1972).
The pain induced in the ceremonythrough piercing, skewering, and tearing par-
ticipants skinis symbolic, sacrificial, and generative. It recalls historical memory
and creates new subjects, partly through the transfer of pain and knowledge and
partly through divination of new and meaningful futures.
Obviously, there is no fair comparison between the Sun Dance and anexos. But
to understand anexos, it is perhaps useful to put ideas about therapeutic violence
into a broader context. It is perhaps also useful to recall that ceremonies like the
Sun Dance were banned for decades by the U.S. and Canadian governments and
that they have reemerged in substance abuse recovery efforts among many Native
American communities (Calabrese 2013; Prussing 2007).
Taking Padrino Franciscos experience and insights seriously requires more nu-
anced understandings of how and why violence is linked to projects of recoverynot
just in terms specific therapeutic sites and practices, but also the processes of their
formation (Asad 2003).
Indeed, the conceptual displacement of violence from the therapeutic domain is
revealed as ideological fantasy in the anexo. This is not only because of the diversity
of healing systems that exist globally, but because violence is integral to everyday
life in Mexico. How could violence be absent from recovery here if it is present
everywhere else? Why treat the violence of the anexo as if it existed independently
of the world in which it is situated? The question is not how to rid violence from
this particular domain, as if the restoration of a nonviolent and untraumatized
Mexico was even possible, but to better understand what violence here is intended
to produce. In my view, such a query is not nihilistic, complicit, or despairing, but
a necessary reckoning with a difficult reality.
The question of whether anexos work, or whether Padrino Francisco recovered, is
understandable, especially given biomedicines moral imperative to define health
and treatment outcomes (Lupton 1995). But I have tried to restate this question
in terms of what is sought in the anexos disparate valence of recovery. I offer a
tentative answer: Neither invulnerability nor cure is sought; instead, what is at stake
is a different way of expressing and managing the pain of the self and community.
In this sense, the anexos work of recovery reveals its own indeterminate status, and
the precariousness of life itself.
This article has argued that state reforms and the drug war have facilitated the
spread of anexos and has demonstrated how these forces are enmeshed in local itera-
tions of therapeutic violence and recovery. It suggests that the resemblance between
criminal violence and anexos therapeutic violence is not the confusion or conflation
of forms but the reality of violence increasingly un-thought by its very normativ-
ity. The anexo elaborates this reality as it seeks transformation through it, defining
along the way a field of tensions that call for a rethinking of the relationship between
violence and recovery, pain and healing, and new modes of survival. This returns me
 Violence, Inequality, and Recovery in Mexico City 469

to Rivera Garzas notion of textos dolientes, in which violence is at once a source

terrible wounds, of painful writing, and ethical life. I have tried to attend to this
complexity within the anexo, taking seriously a form of addiction therapy that is
constituted in and through violence. Mexico, today, is utterly captured by violence
in its worst forms. Scholarly engagements with violences redemptive possibilities
are sorely needed.

Notes
Acknowledgments. First and foremost, I thank the padrinos, anexados, and
their relatives for allowing me into their lives. This article benefited from the
critical insight of Nancy Scheper-Hughes, Vincanne Adams, Cori Hayden, and Lisa
Stevenson. Ruben Martnez provided invaluable emotional and logistical support
during this research. Sincere thanks to this articles peer reviewers, and to Brian
Anderson, Monica Martnez Arroyo, Michael Nedelman, Carlos Zamudio, Daniel
Hernandez and Ioan Grillo. Funding from the University of California Institute for
Mexico and the United States and Stanford Universitys Institute for Research in
the Social Sciences supported this work.

1. All interviews took place in Spanish and were audio taped. The names of research
subjects have been changed.
2. The term padrino, which is also used for sponsor, reflects the terminology of
the Catholic tradition of the godparentgodchild relationship, which is consecrated with
Baptism. It thus conveys anexos convergence of religious and secular symbols, which
shapes sensibilities about suffering, violence, and healing.
3. When discussing the drug war in Mexico, it is important to recall that the United
States provides the primary demand and consumption market for drugs produced and
trafficked through Mexico. The United States is also the source of 90% of guns recovered
in crimes in Mexico (see Jones 2010).
4. See Norma Oficial Mexicana NOM-028-SSA21999 para la prevencion, tratamiento
y control de las adicciones. Mexico City: Diario Oficial de la Federacion.
5. The degree of marginality takes into account education, income, patrimony of the
household, and quality of the dwelling (see Delegacion Iztapalapa 2008).
6. Translation is provided by Jen Hofer.
7. In contrast, the first step in traditional 12-steps requires the individuals admission
of his or her own powerlessness over alcohol or drugs.
8. Addiction treatment under coercion and social controls have a long history in the
United States and continue in strategies like drug treatment courts. For more on this history,
see Campbell et al. (2008). For more on the current debates surrounding coercive treatment
in Euro-American countries, see Urbanowski (2010). For more on harsh approaches to
addiction treatment in Russia, see Raikhel (2012).
9. Often, the first step is also experienced as betrayal by the family, at least initially.
10. A few women reported being paid for successfully referring new patients, and
making and posting advertisements. While minimal, such earnings are economically and
personally significant.

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