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All the Beauty and the Bloodshed shows Nan Goldin's fight to hold the Sacklers accountable for role in opioid crisis

Artist Nan Goldin overdosed on the opioid fentanyl in 2014 – the same year she was first prescribed OxyContin. (Supplied: Madman)

"Even if relationships are destructive, people cling together," photographer Nan Goldin writes in the introduction to the 1996 edition of her seminal monograph The Ballad of Sexual Dependency, originally published in 1986.

She continues: "I have a strong desire to be independent, but at the same time a craving for the intensity that comes from interdependency. The tension this creates seems to be a universal problem: the struggle between autonomy and dependency."

Listen: Director Laura Poitras on ABC RN's The Screen Show

The Ballad is a collection of personal images that chronicle the artist and her friends and lovers, who are depicted in repose or posing in various dingy boudoirs and bathrooms with a startling snapshot candour.

By the time of the book's publication, Goldin had been exhibiting The Ballad for years in the form of a constantly evolving slide show set to music, and she would continue to do so long after – eventually going from underground clubs and cinemas to top-tier galleries and museums.

All the Beauty and the Bloodshed, the unflinching, Oscar-nominated documentary helmed by Laura Poitras (Citizenfour), is also about a "struggle between autonomy and dependency" – one waged by Goldin as well as millions of others whose collective stories make up the North American opioid crisis.

"Nan's art and vision has inspired my work for years, and has influenced generations of filmmakers," Poitras told The Hollywood Reporter. (Supplied: Madman/Nan Goldin)

Goldin became addicted to the OxyContin she was originally prescribed for the tendinitis in her wrist. She turned to the black market when she could no longer wrangle scripts, before eventually working up the courage to check herself into rehab in 2017, well aware that the level of care she was able to pay for is beyond the means of most.

In a piece composed for Artforum and published about a year after she got off Oxy, Goldin bravely recounts the dark particulars of her habit – how it developed "overnight"; how she used an endowment to fund it – and announces her intent to mobilise her considerable art world clout against the Sacklers, the family behind OxyContin.

Hers was a doubly personal vendetta: Not only was the Sackler family firm Purdue Pharma behind the development and distribution of the highly addictive pills, but their name was emblazoned on many a lofty chamber in museums the globe over, from the Metropolitan Museum of Art to the Tate and the Louvre, including a number of institutions that hold work by Goldin in their collections.

Goldin had input into what material was used in the movie – including her previously undiscussed experience as a sex worker. (Supplied: Madman)

Poitras's documentary, which won top prize at the 2022 Venice Film Festival (becoming the second ever non-fiction film to do so), might therefore be thought of as a "ballad of chemical dependency".

With skill and sensitivity, the filmmaker interweaves Goldin's activism – her efforts to raise awareness of the Sacklers' role in fomenting the opioid crisis and to have their name removed from art institutions ­– with a biography of the artist and the grimy-glamorous downtown Manhattan scene in which she was enmeshed.

It's a bruising film, detailing a deeply repressive upbringing in the suburbs of Boston, marred by the suicide of Goldin's elder sister, aged 18, as well as the deleterious impact of the AIDS crisis on those who comprise The Ballad's vibrant, defiant cast of characters.

"It's my story told through my photographs—there's not a lot of footage shot by other people," Goldin told Artnet. (Supplied: Madman)

There are also notes of triumph, however. Building on the work of journalists Patrick Radden Keefe (one of the on-screen interviewees), Margaret Talbot, and Christopher Glazek, Goldin and her advocacy group (P.A.I.N. – Prescription Addiction Intervention Now) do gain measurable ground against their adversary: Purdue files for bankruptcy; multiple major institutions sever ties with the family.

The Met is one of them. All the Beauty and the Bloodshed opens with handheld footage of its largest hall, one of seven in the museum named for the Sacklers, and recognisable as the home of the 2000-year-old Temple of Dendur, relocated from Egypt. Goldin and her comrades in P.A.I.N. fan out across the room and begin to chant: "Temple of money! Temple of greed! Temple of Oxy!" They throw bright orange prescription bottles into the shallow moat that skirts the sandstone structure – an eye-catching touch – which are left to bob accusingly as the protesters proceed to lie down on the floor, staging a "die-in".

In 2021, the Met removed the Sackler name from all seven exhibition spaces. (Supplied: Madman)

Such sequences are of a piece with the explicitly political bent of Poitras's other work. Less so, it would seem, those passages in the film dedicated to Goldin's life and art, patterned after The Ballad's slide show form. Goldin's subject matter – her intimate, diaristic explorations of interpersonal relationships and queer nightlife – has little in common with the political highwire acts of Edward Snowden and Julian Assange (as documented in 2014's Citizenfour and 2016's Risk, respectively).

When Poitras was suggested as someone who could piece together the footage that P.A.I.N. had already amassed with a view to making a film, Goldin herself assumed that the filmmaker wouldn't be interested. "I don't have any state secrets," she thought.

And yet, the old second-wave feminist dictum holds true: The personal is political.

The National Portrait Gallery in the UK was the first major institution to reject a donation from the Sackler family. (Supplied: Madman)

Given the decimation by AIDS of the creatively potent scene to which Goldin belonged – amongst the deaths mourned by the film are those of artist David Wojnarowicz and writer and actor Cookie Mueller – it's significant that P.A.I.N.'s tactics are modelled on those of ACT UP (AIDS Coalition to Unleash Power). This grassroots group was founded in 1987 in New York (followed by chapters across America and the globe) in response to the government's total failure to address the crisis – its inaction a particularly chilling manifestation of systemic homophobia, tantamount to a death sentence for those afflicted.

As with AIDS in Reagan's America, social stigma has been an obstacle to the proper redress of the opioid crisis – something that Goldin targets through speaking out about her own experience, and by drawing attention to the calculation and corporate interests that lie at the epidemic's roots.

Poitras is careful to let Goldin speak for herself – the filmmaker is not a character whose presence impacts the action, as she has been in previous films – but her hand is felt in the structural highlighting of the tragic parallel between the two health crises, one being the film's raison d'être and the other something that has retroactively shaded Goldin's work.

The artist's survival (of childhood trauma first, then the AIDS crisis and addiction) figures as a testament to her remarkable, tough-as-nails constitution at the same time as it is a tragic reminder of all those lost – sacrificed, really – to both dependency and disease.

All the Beauty and the Bloodshed is in cinemas from March 9.

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