Harm Reduction as Pedagogical Praxis: Confronting Capitalism in the University Classroom
CE Mackenzie, University of Pittsburgh
Date posted: January 2022
MacKenzie, CE. (2022).”Harm reduction as pedagogical praxis: Confronting capitalism in the university classroom.” Rhetoric of Health and Medicine, Vol. 4 : Issue 4, Article 1.
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Abstract: In this essay I bring together two spaces—street needle exchange and the university classroom—to explore harm reduction as an epistemological model that can be adapted pedagogically in our rhetoric, communications, and composition classes. I first identify capitalism in the classroom as an insistence on mastery and the relentless call to know, acquire, and achieve. I then offer harm reduction, a public health practice that rejects these iterations of capitalism, to instead ask how we might meet students where they are and how we might forego the rewards of telos for the discomfort of process and mess. I’ll argue in this piece that reducing the harms of capitalist-based writing and knowledge requires considered attention to the ways we are lured toward production (what we might even call “deliverables”). I explore the epistemological nodes of harm reduction—its emphasis on temporality and its privileging of process—as methods for teaching writing, rhetoric, and communications while also offering a pedagogical case study along the way.
Keywords: Harm reduction, pedagogy, US opioid epidemic, rhetoric, capital
From Syringe Exchange to the University Classroom
For years I spent my Monday nights parking an old RV at the terminus of Blair Street in Eugene, Oregon. Having stocked the RV with sterile needles, cookers, condoms, hot coffee, tampons, Naloxone kits, and day-old baked goods, the needle exchange (NEX) team and I would then climb in and head to the fray of downtown. We always parked on the same dead-end next to the railroad tracks to set up tables and unload supplies while clients gathered. Often the train thrashed past and I found myself trying to yell over the metal scream of tracks, have you exchanged needles with us before?!Collecting their used needles and offering packs of 27 and 29-gauged sterile syringes in return, the scene at exchange was one of motion—people coming and going, relationships forming, laughter alongside ache, and care as a humming, shifting thing.
Our knowledge on drug use has been manipulated and overexposed by the War on Drugs and the opioid epidemic. Told that drug use is only pathological, is only criminal and disordered, we are left to imagine rehabilitation as the only legible solution. But this narrative is coerced. It defines drug use through capitalism and manages the flow of profits through privatized carceral regimes. Meaning, drug use has been made a spectacle in order to maintain the image of the white, working citizen while simultaneously regulating, suppressing, and incarcerating communities of color. As I use it here, I borrow from Lauren Berlant (2011) to define capitalism as a force that overwhelms our lives and impels us always and inevitably toward profits and products, saturating our social worlds in consumption, commodification, and co-option (p. 192). At NEX, even as I saw people living dynamic, vibrant lives marked by care and connection, I also witnessed the body as exhausted by the compulsory demands of capital—that one pursue health, wellness, and recovery at all costs.
Rather than insist on recovery, rather than demand delineated futures, harm reduction rejects these iterations of capitalism to meet people in their moment of need. Harm reduction offers care without requesting one work toward recovery in order to access resources and services. Harm reduction links non-judgment with non-coercive service, describing drug use as multi-faceted and located on a continuum. Meaning, we’re all in process. If traditional healthcare has privileged the cured condition, then harm reduction dismisses this “telos” (that there should be some defined end state) to instead take up the temporal uncertainties of the moment. Harm reduction recognizes that all of human experience hums within the mess of now, that we may or may not arrive at scripted destinations. We may not seek recovery, but that should not preclude access to needed resources, services, and care.
If we cannot escape capital—and I don’t believe we can—how do we find ways to resist the force it applies to our bodies and the definitions it gives our lives? As I began my doctoral program, leaving street exchange for the university classroom, I began to translate harm reduction beyond public health. By subverting the recovery model and its capitalist logics, harm reduction is not only efficacious health policy, but a whole way of thinking rooted in care, temporality, and process. Its pedagogical possibilities could transform our classrooms.
In this essay, I first define harm reduction, expanding on my own experiences with my needle exchange crew in Eugene, OR from 2016 to 2018. I then translate these experiences into my teaching philosophies and methods that I developed as a TA, clarifying explicitly how harm reduction as pedagogical potential can deepen student engagement with their writing and work. I use an assignment I created called The Mixtape to illustrate the uses of harm reduction-driven pedagogy and to point toward ways of adapting harm reduction in our writing, rhetoric, and communication classrooms. Finally, I conclude with specific suggestions for those interested in pursuing this approach in their own teaching.
The Rhetorics of Harm Reduction and its Pedagogical Import
Our collective take on drug use in particular, but wellness more broadly construed, is rooted in capital. We need only look toward our origins. The US healthcare industry was founded through the imperialist drive to own and to make known, to make the flesh an identity, and to contain and “civilize” what was in excess. C. Riley Snorton (2017) argues this explicit point when he asks, “What does it mean to have a body that has been made into a grammar for whole worlds of meaning?” (p. 11). Likewise, Siobhan Somerville (2000) lays bare the eugenic rhetorics that came to define early sexology, how sex and gender were braided within racial taxonomy to optimize a culture of regulation, what she names “a discourse saturated with assumptions about the racialization of bodies” (p. 4). By applying her analysis to rhetoric, Somerville brings attention to the recursivity of both bodies and languages, that “the particular meanings of socially constructed identities gain currency through repetition, resistance, and appropriation” (p. 14). The more we call someone “clean” the more we re-inscribe drug use as dirty. By regulating our definitions of health through recursive iterations of capital—through the teleological language of betterment, intervention, and progress—we coerce one another, even under the auspices of care, toward determined ends. The problem is neither rhetorical nor epistemological. The problem is capital and the way it naturalizes our attachments to linear health and acquired recovery.
I trained for several days before becoming an outreach worker, learning how to administer Naloxone, that Hep C lives outside the body for up to six weeks, that detergent bottles make useful sharps containers. But most emphatically, our lessons were rhetorical. Indeed, at NEX I gained a definition of rhetoric that would come to inform my politics, my epistemological investments, and my pedagogical habits: our language forms or forecloses material possibility. Rhetoric—as I define here and as I came to understand it through NEX—is the textual energy that shapes materiality. It is the thrumming percussion behind our messy assemblage of living life. Rhetoric envisions and elaborates our social world.
In harm reduction, specifically, this meant that what we said directly influenced our clients’ experiences and decisions. For example, we never used words like “clean” and “addict,” because these rhetorical recursions crystallized a broader social understanding of drug use—that it is dirty and antisocial. Similarly, if a client excitedly shared their sobriety with us, we did not celebrate alongside them or congratulate their sobriety. Instead, we would ask how they were feeling. Because if they went on to relapse they might remember our shared celebratory moment (and its implicit expectation of recovery) and not return to seek assistance. Harm reduction works ceaselessly to protect what is in process.
When I first left my role as an outreach advocate in Oregon to pursue my doctorate in Pennsylvania, I worried I’d be leaving behind praxis for theory. As I began my research on the rhetorics of drug use and addiction—as coursework spilled into exams and into a dissertation—I found myself immersed in biopolitics and biocapital, biocitizenship and biolegitimacy. As much as I love my research, I also ached for those days driving around in an old RV, passing out syringes and condoms in the streets of Eugene. When I became a TA, I faced even more intimidating unknowns: curriculums, lesson plans, and teaching philosophies. I struggled to know my place in the classroom, a space vibrating with an imbalance of power. A space organized by teleological markers (grades, finals, teacher evaluations). A space soaked in performance and projection. While I will not spend time here describing the ways capital has formed and informed the university, it’s worth noting that those ways are innumerable and constantly felt. We labor and create product. We protect our futures by our performances in the present. We optimize ourselves. We work within slow death while accruing debt. We believe all knowledge is ours for the taking: at the end of my first term when I’m grading final reflection papers, a student asks me what my sex is. Not my gender or my pronouns, but my sex. (I don’t respond.)
After this first term of teaching, I knew I had to find my own way and that I desired the same for my students. I wanted to create a community that was, of course, safe but also actively working to diminish harm. That’s when I returned to my NEX roots and began to translate harm reduction into pedagogy. I believe, regardless of subject section or course number, harm reduction can be adapted in the classroom to encourage students to sit in mystery, to sit with their questions, and to unlearn domination as a form of literacy. Specifically, I took from harm reduction two crucial ways of thinking about the self: that we are always in process (and this process is uncertain, temporally focused, and bound up in feeling) and recovery is not the goal. Translated to the space of any rhetoric, composition, or communication class—our work, including our own criticality, can never be mastered, nor should it. As writers and thinkers, we are in process. Just as we do not need to be in recovery in order to recognize ourselves as full, feeling agents in our lives, we do not need a formed thesis statement in order to write. We don’t need to explain ourselves in order to describe ourselves. We don’t need to know the future in order to work toward it. Just as harm reduction recognizes the nonlinearity of need and being—that we “take steps” forward and back, but also sideways and inwards—so also might we call this the process of imagining, creating, and revising. As a comp teacher I hope to show how process comprises most of writing and is perhaps the act of writing in and of itself.
The Mixtape: A Case Study of Harm Reduction in the Classroom
My students often enter the classroom with acute anxiety about academic performance, with the presumption that we should all be knowers rather than learners. They (like most of us) have been trained under the ethos of no child left behind and through relentless call of capitalism—to produce and achieve. But when we ask students to assume expertise we stigmatize process and pathologize not knowing. And nothing inhibits us quite like stigma, as any NEX worker or person who uses drugs will tell you. If our students are asked to navigate complexity by diminishing (rather than sustaining) complexity, if they then internalize shame as their failure to do so, we’ve only replicated capitalism in the classroom. So, in my first-year writing classes, we spend our early weeks with Audre Lorde’s 1984 essay “Poetry Is Not a Luxury,” converging on the line, “There are no new ideas. There are only new ways of making them felt” (2013, p. 39). In an effort to move toward feeling and away from dominance, we reiterate again our status as non-experts. And when we embrace ourselves as non-experts, instead seeing ourselves as desiring beings who feel and fumble, we begin to practice a criticality that we can take into our work and the world.
Reducing the harms of capitalist-based writing and knowledge in my classroom requires relentless attention to the ways we are lured toward and rewarded by production. Because teaching is inherently anxious and precarious work, especially for graduate students, we are incentivized toward “deliverables,” tangible bits of evidence that signal learning, or at least work being done. But, if literacy is an event, not a product, what does that ask of us as teachers? As I return to this question, I reframe it through harm reduction praxis: how do we emphasize process in a space marked by assessment; how do we forego the academic rewards of telos for the discomforts of feeling? Finally, how do we immerse ourselves in connections and community but resist conclusions?
More than any other unit in the semester, the research section is notoriously anxious – maybe even dreaded. I cannot help but see the parallels between capitalist logics and the ways we construct, describe, and assess research. For most of my students’ elementary and secondary education experience, they were awarded good grades for clear theses, contained arguments, and definitive voice—to argue and conclude. They were trained to know. And they were trained to consider composition as the distillation of knowledge. I want to show my students how the discomfort of process, of being within the continuum of care and feeling, can open up their writing and elicit more possibilities for expressing ourselves. As their teacher, I understand my responsibility as guiding them away from the faux security and stability of cured states and tidy endings. At the start of our research unit I ask them what parts of writing invoke the most anxiety. I then fill a blackboard with their answers, many of which I hear repeated each term: arbitrary word counts, thesis statements, boring topics, citational labor, unwieldly search engines, conclusions. Rather than classify these responses as typical first-year student grievances, I think it’s important to really listen to what is being said: students long to care. And the forms are failing them.
After we share our writing woes during the research unit, I draw up and assign what I call the Mixtape Project, foregoing the formalities of the traditional research paper with the hope of leading students into other imaginary possibilities and reducing the harms wrought by the mastery model. At this point in the term, we already spent weeks collectively discussing and defining power, finally moving into the spaces power inhabits: healthcare, citizenship, religious institutions, the two-party political system, public education, private education, the carceral state. I ask students to first identify a system they are interested in exploring. And rather than assign the research paper as the form through which to investigate their systems, I assign a mixtape. The Mixtape simulates an annotated bibliography (though I don’t use that language) in that I ask for eight to ten songs or “texts” that speak toward their system. We spend class time discussing what makes a good playlist. We spend class time discussing citational labor. I ask them what a “text” does(rather than what it is). We agree that a text communicates and expresses feeling. I again fill a blackboard with their suggestions on those “texts” that extend beyond the page: music, fashion, social media, podcasts, tattoos, and more. Because each “text” communicates meaning out into the world, my students practice expanding their critical gaze. They begin to see the world as saturated.
The Mixtape asks for eight to ten “texts” but what is starkly missing is the thesis statement. Through in-class activities, informal reflections, and smaller assignments that build up into the Mixtape, I witness my students making fluid connections without conclusion or declaration. They write to describe. They look toward others. When I first designed this assignment, I expected students might be relieved to merely collate and summarize texts rather than stake master claims, what they often describe as “formality.” What I did not anticipate was that by removing coercion from the writing requirement, students made organic connections. Just as at NEX, by removing the expectation of rehab or recovery, clients felt safe to participate in exchange in their own way and on their own terms.
Without a thesis statement, students only had to gather voices, items, artifacts, glimmers. One student commented in their Mixtape reflection that, “By building the playlist, I didn’t have to worry about forcing connections between the texts. I was able to write individually about each one and then once finished, collectively look at them, almost as a puzzle, and create connections that were real and meaningful” (Student 6, 2019). In this way, we encouraged one another to stay within the puzzle, within the question, rather than run toward punctuation. No thesis, no conclusion, just the movement between ideas. At the dead-end of Blair street, NEX was available every Monday with the same carafe of dark coffee, ready to chat about our weeks and needs.
While the Mixtape assignment helps first-year students think beyond the scripts of traditional research papers, the purposes of the project are multiple and adaptable. Though primarily designed to avoid the traps of staking master claims and instead attending to description, the assignment also asks us to reimagine our definitions of rhetoric, composition, and communications. Rather than focus on what rhetoric is, for example, it asks us what rhetoric does. My students shift their gaze from objects (even as they collect and describe objects) to instead investigate the moments, places, and instances where textual connections happen. We might call this a temporal focus. We might interpret this labor as the work of tracing the elusivity of language through the messy assemblage of being. Students are able to work across disciplines, merging discrete fields and methods (from qualitative analysis to critical theory) to gain a fuller perspective on their home departments and the arguments therein. That to say, knowing the voices, movements, arguments, figures, and events that circulate through and shape our specific industries and fields, be it public humanities or public health, is a crucial professional and intellectual asset.
Just as one can translate the Mixtape across disciplines and departments, so too can it be translated across academic years. For example, by extending the requirements to include more texts or certain textual forms (say, medical journals or forms of rhetorical praxis), a fourth-year enrolled in a senior seminar could begin to collate their source work for graduate school. The Mixtape can be tucked into a larger, semester-long research project for any rhetorics, composition, or communications classroom, serving as the bibliographic foundations for long-form research. The assignment is adaptable outside the bounds of these departments too. From anthropology to music theory, the Mixtape is about immersion; we immerse our students and ourselves in source material, whether within the pages of peer-review or through the ethnographic encounter of a street clinic. In this way we refuse to treat research as appropriation, acquisition, distillation. The Mixtape underscores dialog.
Rather than view the citational process as the work of dropping evidential bits into our writing, pulling singular quotes from intricate texts, instead we see our sources as in conversation with one another and ourselves. Like being at NEX, our chatter is at once quotidian and meaningful. We are there just to pass along sterile equipment, not to dispense expert advice. But in the accumulation of our time together, we gain more nuanced insights into the reality of drug use. This work is the work of rhetoric, to dialogically engage ourselves and our imaginations with the material realities of our worlds.
Regardless of whether we teach first-year composition or a senior seminar in health communications, the Mixtape is designed to help students see (and feel!) saturation. It elevates alternatives sources so that we might think outside of (or against) mainstream and traditional institutions. Agency takes many forms. The Mixtape asks us to pivot our critical eye to networks of power, rather than individuals. It helps us track the flow of meaning. If I curated a Mixtape for this essay, for example, I might include Naloxone as one of my “songs” or texts, tracing its temporal condition through rhetorics of overdose. I would describe the minimal space it takes up in our bags and pockets. That it is easily acquired through online health co-ops. That the phrase “Carry Narcan” indicates the everydayness of care currently absent in how we treat drug use and addiction. That actually, this everydayness is an anecdote to what is made a spectacle.
Harm Reduction is Not Liberation: Care Under the Duress of Capital
If harm reduction meets people where they are, privileges process over results, and considers care as a daily act rather than an institutional service, then we might think of our classrooms in a similar way. Across curricular contexts, harm reduction can be adapted in your own course in numerous ways. Perhaps you give students a choice in assignments as a way to meet them where they are. Perhaps you practice revision and forego a final. Perhaps you open each class with an energy check. The Mixtape is just one route to take when considering how we might pull students away from the lure of grades and academic performance. It won’t be easy.
Though harm reduction is an alternative to anti-police methods and anti-capital desires, it is contained within a system of markets, surveillance, and control. Our NEX work existed within the realities of a drug epidemic, one that collapses the pathological and the punitive to limn the person who uses drugs as forfeiting their future, as passive and non-productive. During outreach we were also required by our donors to ask, before distributing any sterile needles or supplies, whether the client wished for recovery services. This question was enforced by funding and organized taxonomically: we asked if they wanted rehab info, when their last Hep C and HIV tests were, if they shared used needles in the past week. By tracking the using patterns of our clients, and by signaling recovery, we appeased these donors who wanted to know their donations endorsed and produced positive results. Thus, our harm reduction work was swept up into the national discourse on health. Because even as we were rhetorically trained away from reiterations of productivity and expectation at NEX, the demands of funding and community opinion still warped the work we’re trying to do.
As with harm reduction, I do not believe our classrooms are sites of liberation but instead scenes of ongoing care and attention. Which is not to say they do not have the possibility to liberate, only that American higher education is underwritten by imperialism, historically and as an ongoing matter of fact. Rather than teach students to sit with uncertainty and to understand themselves as limited knowers but vibrant feelers, the university assesses students for enacting mastery. I think we could describe these maneuvers as colonial—to name and contain. Burdened by outcome, taught to fixate on futures, what possibilities do we leave for process? On the first page of every syllabus I write, “we are not experts and we do not need to be.” It takes a full term (and beyond) to forge trust in this line.
Harm reduction work is endless and circular. But this is not dire. This is what it means to practice care under the saturation of capital. We cannot ignore or even escape the systems within which we are always complicit. The on-the-ground task—of policy makers, outreach advocates, loved ones, support services, of those using drugs and those who love those using drugs, of teachers and students—is to reject productivity and mastery as barometers of being. Always protecting process, this kind of care refuses predictions on the future and turns instead toward the acute service of now, this moment. Without demanded outcomes, harm reduction ascribes an un/knowing that is deeply felt and deeply committed to process. It is the mantra, one day at a time. Audre Lorde has already offered us everything we need—there are no new ideas, only new ways of making them felt.
CE Mackenzie, PhD candidate at the University of Pittsburgh, studies at the intersections of health rhetoric, trans and affect studies, and theories of epistemology. Their work can be found in a range of places, including QED: Journal in GLBTQ Worldmaking, Prose Studies, Kairos: A Journal of Critical Symposium, and others.
Berlant, Lauren. (2007). Slow death: Sovereignty, obesity, lateral agency. Critical Inquiry, 33 (4), 754–780. https://doi.org/10.2307/4497751
———. (2011). Cruel optimism. Duke University Press.
Foucault, Michel. (2008). The birth of the clinic: An archeology of medical perception. London: Routledge.
———. (1990). The history of sexuality, volume 1: An introduction. New York: Vintage Books.
Harm Reduction Principles. (2020). National Harm Reduction Coalition. https://www.harmreduction.org/about-us/principles-of-harm-reduction
Lorde, Audre. (2013). Poetry is not luxury. In Sister outsider: Essays and speeches. Ten Speed Press.
Somerville, Siobhan. (2000). Queering the color line race and the invention of homosexuality in american culture. Durham: Duke University Press.
Snorton, C. Riley. (2017). Black on both sides: A racial history of trans identity. Minneapolis: University of Minnesota Press.
Student 6, Anonymous. (2019). Mixtape catalog reflection. Seminar in Composition, University of Pittsburgh, unpublished student paper.
 The historical and epistemological eugenic roots of healthcare continue to engender new, violent growth in the US medical-therapeutic industry. Naturally, we can look to Foucault. Through sex, Foucault argues, one gained access to their own intelligibility (a coherence that translates socially to others). This access emerged within a significant historical transformation, wherein one’s behaviors, performances, and flesh became identity. For example, same-sex sex was no longer registered ephemerally, as a temporal act, but was compounded into identity: sex became homosexuality, which allowed the state to regulate and police what it rhetorically self-authorized as deviance. See Michel Foucault’s The History of Sexuality and also The Birth of the Clinic.
 Slow death, as conceived by Lauren Berlant, describes a sociality saturated by consumption and capital—the vibrating, stressed everydayness caused by the markets’ influence on everything from desire to knowledge, entertainment to instagram influencing. But more pointedly, slow death is the quotidian “destruction of bodies by capitalism in spaces of production and in the rest of life” (p. 764). See Lauren Berlant (2007). “Slow death,” Critical Inquiry 33 (4), 780. She explains also how within slow death, capitalism conflates the creation and attrition of human life, rendering them indistinguishable.
The MIXTAPE project // assignment
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We’ve been talking about power and institutions. You’ve already written about “a broken system” in your last assignment. Then together as a class we made mixtapes as a way to define, discover, and curate “texts.” Now I want you to put it all together. I want you to create another mixtape, this one a bit longer and about your broken system.
Remember what makes a good playlist. The songs are thematic, but they vary in tone and mood. They speak to one another while also standing alone. Please reach out if you want to think through your mixtape with someone.
- No thesis. No conclusion. No transition sentences. Instead:
- A one-page introduction to the mixtape that tells me what system or institution you’re researching and how your 8 “texts” together help you think about the issue at hand.
- Eight to ten entries each with minimum 100-word explanation
- Each explanation should be both summary and analytical (that is, tell me why this is an important text to include on your playlist, not just what the text is and says).
- Include quotes or lyrics or visuals!
- TWO of your entries must be sourced from PittCat (an academic journal or an academic book) OR from something we’ve read/watched this term
Entry possibilities: documentaries, songs, news reports, protest art, manifestos, speeches, political events, academic articles or books (check out PittCat), memoirs, fiction, poetry, biographies, comics, political figures, an archival object, a symbol or flag, a year in time, a twitter thread, texts we’ve already read in class, etc.
When citing: you do not have to use formal citation (eg., mla). Just give me enough to go off of. For example:
Entry 1: sam sax’s book of poems Madness
Madness is sam sax’s debut collection of poems. It confronts the stigma and shame associated with mental health, sexuality, and substance abuse. sax uniquely begins each section in Madness with long quotations from the DSM, illustrating the troubled history of cloaking so much of life as disorder. In Madness sax situates the reader at the intersections of addiction, recovery, desire, queer embodiment, and family history. He creates a tactile reading experience wherein everything is connected and implicated and nothing is judged. For that reason it helps me think through what it means to categorize people and why mental health, as an institution, needs to move beyond categories in giving care.