Kelly Ray Knight

Durham, NC:  Duke University Press, 2015, 328 pp.

Reviewed by Parsa Bastani


Kelly Ray Knight provides a chilling account of drug addiction and mental illness among addicted, pregnant, poor women that move in and out of daily rent hotels in the Mission district of San Francisco. The entire book is an effort to understand the forms of life that are possible for these women, with whom Knight established an intimate rapport through years of work as a public health outreach provider. Knight fully reveals the harrowing insecurities these women face, outlining the competing demands enforced upon them by drug addiction, pregnancy, changing welfare policies, and various institutions of care and coercion (police, daily rent hotels, and service providers).


The daily rent hotels serve as the main site for Knight’s research. They provide respite from the violence of the streets for her protagonists. More critically, these hotels also serve as sites of exploitation, charging exorbitant fees, encouraging sex work, and instituting evictions every twenty-one days to avoid tenancy claims. Knight’s unconventional inclusion of longer fieldnotes allows readers to share her sense of intimacy with her interlocutors. In addition, her inclusion of photographs of daily rent hotel living conditions serves as a reminder of these women’s invisibility amidst the gentrification wrought by San Francisco’s tech industry boom.


Knight’s exciting theoretical intervention about temporality throws into relief the complexity of her interlocutors’ lives. She posits that anthropologists should no longer ask “who” the homeless are but “what temporal registers matter” for making sense of their situations (p. 71). This allows her to unhinge totalizing characterizations that categorize all homeless people as being either mentally ill or not, addicted or not. Such characterizations do not permit a nuanced understanding of the temporally bounded social circumstances that force women to embody fluid ontological states (p.71). In chapter 2, she fleshes out the temporalities that mattered for making sense of addicted pregnant women: addict time, hotel time, pregnancy time, jail time, treatment time, epidemiological time, biomedical time, memorial time, life time. The collision of these temporalities provides insight into an empirical quandary Knight observes during her fieldwork: if services (housing, medical, social) exist for addicted pregnant women, then why are they underutilized or inconsistently utilized (p.231)?


Knight weaves throughout addicted.pregnant.poor the incommensurability of addict time and epidemiological time with welfare policy and service delivery. In 1996, the US Congress approved the Contract with American Advancement Act that denied Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) to those people who claimed drug dependency as their primary disabling diagnosis. Mental illnesses, though, remained qualified. Welfare reform went against scientific evidence showing that addiction is a chronic disease and that there is a co-constitutive relationship between mental illness and substance abuse (p.124). The state of California invested in what Knight terms “neurocrats,” or intermediaries who must testify that the individual in question is suffering from mental illness not induced by substance abuse in order to keep people enrolled in federal welfare programs (chp. 3).


Despite scientific findings to the contrary, service providers and the public continue to regard drug addiction as a choice, indexical of irresponsibility and immorality. As Knight points out, these women embodied the stereotype of “toxic mothers,” likely to bequeath their flaws to offspring (176). She presents harrowing stories of “stratified reproduction” at its worst (chp. 5). Welfare support (access to drug treatment, food stamps, housing assistance) existed for the fetuses but not the pregnant mothers. The scope of available welfare services was even further restricted by rules barring women with drug-related felonies. After the child was born, the women frequently could not maintain custody, as it was generally conditioned on their moving into drug treatment, finding employment, gaining disability support, and obtaining residence outside daily rent hotels. With mixed feelings, Knight grapples with the fact that incarceration provided the best chance for these women to jump through the necessary hoops of gaining custody of their children. She leaves readers wondering what can be said when the criminal justice system becomes a proxy for care that would otherwise be unused or unavailable to her interlocutors (chp. 6).


Overall, this book is a wonderful contribution to the anthropology of addiction and of homelessness, with a specific focus on gender that is unique and far-reaching. Knight succeeds in humanizing a population that is continually judged, disregarded, and rendered as a failure. The primary shortcoming of this book is a clearer engagement with race. The role of race in making certain forms of life possible, in addition to addiction, pregnancy, and gender, is only infrequently considered. Nevertheless, those interested in the intersection of medical anthropology and gender would benefit greatly from reading addicted.pregnant.poor.



Parsa Bastani is a doctoral student in the Department of Anthropology at Brown University. He holds a MA in Gender and Women’s Studies from the American University in Cairo. His research focuses on governmental and non-governmental initiatives that seek to address the nationally perceived drug addiction crisis in Iran. Specifically, he examines how these interventions engage in the ongoing process of crafting an Islamic society.

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