My grandmother Mildred was the daughter of a successful Black female entrepreneur who opened her own beauty parlor in Oklahoma City in 1911. Mildred was a sharp dresser and an equally sharp money manager: in her mind, her investment funds neutralized her white supervisors’ assumptions of her inferiority. My grandfather Johnnie—whose father had been a railroad Pullman porter in Shawnee, Oklahoma—told stories about walking uphill both ways in the snow to attend segregated schools during the Great Depression.
Mildred and Johnnie were proud and upwardly mobile, but there was also shame and rage in the air. They moved West during World War II because my grandfather had heard that in the Port of Oakland, a Black man could own his own company. And eventually he did. As a child I rode with him to his construction jobs, sitting next to the toolbox in the back of his shiny green 1952 Chevy pickup. He kept its engine, by then three decades old, purring by his constant attention. Oakland was indeed a place where, unlike Oklahoma, some White people would hire Black contractors.
But there was a hitch. More than once I heard the story of my grandfather’s first bout of pneumonia, which he caught working in the rain from Christmas Eve until Christmas Day on the roof of a White family’s home. His workers refused to work in the storm, so he did the job by himself. The White family did not pay him, pointing out that he had promised to finish before the holidays. My grandfather had no recourse in the all-White courts. A string of other failed contracts followed. In the long run, his business was not solvent, but he refused to fold it. Mildred worked in the Oakland schools and, tight lipped, she paid the bills.
Johnnie brought his rage home. He demanded perfection from his sons at school and at home. They foundered under the racist gazes of their teachers, and when they could not deliver, Johnnie beat them. Perhaps as a result, three out of four of my uncles—Bubsie, Billy, and James—struggled with alcohol and drugs. James had left home at sixteen and was heard from once every few years, drunk and cursing at my grandfather. Billy quietly nursed forty-ounce cans in his room upstairs in my grandparents’ house, unable to hold a job or keep his driver’s license due to multiple DUI arrests.
The uncle that was most painful for me to watch was my uncle Bubsie. Bubsie had been a football star in high school, and he was an avid reader who cited the Bhagavad Gita and Abraham Maslow in the same breath. When I reached high school and my mother refused to teach me to drive, he showed up in my room dangling the key to his VW bug from his fingers, prepared to risk his transmission for my freedom. I did not know then that his escalating binges on marijuana and cocaine would precipitate psychotic episodes that left him wandering the streets, muttering to himself and dodging the cars that he thought were following him. Unable to maintain his apartment, he moved back in with my grandparents, but they would not keep him. They were afraid of his outbursts, one of which landed him in handcuffs after he bit off the earlobe of a passerby on Telegraph Avenue. Another attempt at independent living—made while he was still in the throes of cocaine and marijuana use—ended with half his face burned by the bottle of Draino he used to threaten his roommate. Eight years later, in a state mental hospital, Bubsie died of heart failure likely caused by his psychiatric medications.
The irony was that my uncles had come of age during the Civil Rights Movement and were taught to aim high. James joined the military, Bubsie worked toward an engineering degree before dropping out of college, and Billy held a journalism degree. But their thwarted aspirations and substance use formed a vicious circle—shattering my grandparents’ hopes for their sons. My grandmother blamed my grandfather for breaking their sons, and my grandfather blamed my grandmother for emasculating him by controlling their bank accounts. Their angry silence led them to divorce just before their fiftieth wedding anniversary.
Church had been the center of Mildred and Johnnie’s lives; they and many of their childhood friends from Oklahoma attended the Methodist church two blocks from our home. Mildred and the churchwomen planned fundraising fashion shows, and heard financial advisors for their investment club. Johnnie and his church brothers set off from church on Saturdays in pickup trucks to go catfishing at Clearlake, ninety miles north, bringing the catch back to church for fish fries. My brother and I went to Sunday school, and church pageants at Christmas and Easter were occasions for Mildred and my mother to sew me lace-collared dresses and to buy me matching gloves and handbags. When my uncles decompensated, Mildred and Johnnie went to the pastor’s house for counseling. Before their divorce, they went to the pastor in an attempt to stay together.
After their divorce, I alternated between going to the Methodist church with Johnnie, and to Mildred’s newly adopted Black Baptist church half a mile away. My mother, Jackie, was not churchgoing; she was turned off by authoritarian preachers. But as the only one of her siblings who came out of the Civil Rights era with good health and a job, she was a moral standard bearer in the family. She was the child who achieved “perfection.” She went to Stanford on a scholarship, one of three Black students to arrive in 1962. She traveled to Norway on an Eisenhower International Fellowship where she met my father then returned to America, where in two months she married and in three years divorced my father. My mother then earned a degree in social work. As a social worker, she was horrified by the racial patterns of foster care placement, which was often state-imposed on African American and Latina women living in poverty who tested positive for drugs. When I was in elementary school, my mother became the first Black Ph.D. student in U.C. Berkeley’s developmental psychology program. Her mission was to correct racial bias in theories of child attachment that led to harmful foster care placements. Unfortunately, she was in the same department with Arthur Jensen and other proponents of racial-genetic determinants of intelligence. She got her degree, but she also challenged the claims of key faculty members, who saw to it that she did not get a viable academic job. Shut out of a research career, my mother returned as a social worker to a child protective service department where county guidelines forced her to place children in foster care against her will and against her knowledge of child development.
As pressures mounted, my mother’s perfectionism became puritanical. Almost no processed sugar or caffeine passed her lips. She never used profanity, always kept our house meticulously clean, and monitored my every excursion. Later in life I realized that my grandmother’s aunts and cousins—recent arrivals to California from Texas and Arkansas who my mother avoided because they had “strange ways” (they would not dance or show their legs)—were Holiness Pentecostals. My mother had more in common with them than she would admit. She embodied the ascetic personal morality characteristic of African American Holiness Pentecostal movements (Sanders 1996).
My uncles must have resented her. Uncle Bubsie once showed up at our door intoxicated, cursing and banging on the door hard enough to break its hinges while I hid behind the couch. Uncle James only came by to see my grandparents when my mother was not there, detonating his own drunken explosions. By the time I reached Puerto Rican street ministries, much about the strict daily discipline of ministry routines and the chaos of family life that the routines were supposed to guard against seemed familiar. Bubsie’s death was followed by James’ death from cocaine-related kidney failure. Billy drifted in and out of unemployment, but after my grandfather died, he joined Alcoholics Anonymous and my grandmother’s church. He got credentialed and eventually taught English in the same middle school in which my grandmother had worked.
My family’s frustrated aspiration, tenuous class background, and ethnic marginality guided my ethnographic curiosities. Although I had to check my tendency to project my family’s concerns onto my island Puerto Rican informants, identifying with my informants might have enhanced my patience regarding our differences, as well as my interest in their self-image as members of families and communities rather than as deviants.2 I noticed that my practice of inviting ex-cocaine and heroin users to my home was not matched my professional colleagues. As a public health researcher in Puerto Rico asked me in disbelief, “You mean, you let your daughter meet the addicts?”
Like most biomedical practitioners in Puerto Rico and the United States, I was taught the Biopsychosocial